Forms Relating to Military Service Records

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3095-0039 can be found here:

Documents and Forms

Document Name Document Type
Form NA Form 13036 Forms Relating to Military Service Records Form and Instruction
NA Form 13036 Authorization for Release of Military Medical Patient Re NA 13036_14FINAL.docx www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html Form and Instruction
NA Form 13042 Request for Information Needed to Locate Medical Records NA 13042_14FINAL.docx www.archives.gov/st-louis/military-personnel/na-13042-request-4-information-needed-2-locate-medical-records.pdf Form and Instruction
NA Form 13055 Request for Information Needed to Reconstruct Medical Da NA 13055_14FINAL.docx www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstruct-medical-data.pdf Form and Instruction
NA Form 13075 Questionnaire about Military Service NA 13075_14FINAL.docx www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-about-military-service.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Forms Relating to Military Service Records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 36 CFR 1233.18

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA Form 13036	Authorization for Release of Military Medical Patient Records	NA 13036_14FINAL.docx	http://www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html	Yes	No	Fillable Printable
Form and Instruction	NA Form 13042	Request for Information Needed to Locate Medical Records	NA 13042_14FINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13042-request-4-information-needed-2-locate-medical-records.pdf	Yes	No	Fillable Printable
Form and Instruction	NA Form 13055	Request for Information Needed to Reconstruct Medical Data	NA 13055_14FINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstruct-medical-data.pdf	Yes	No	Fillable Printable
Form and Instruction	NA Form 13075	Questionnaire about Military Service	NA 13075_14FINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-about-military-service.pdf	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 79,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	79,800	79,800
Annual IC Time Burden (Hours)	6,650	6,650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.