Information Collection

Designee For Patient Personal Property

IC 211131 under ICR 201410-2900-006 · OMB 2900-0817.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY	Form and Instruction
10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 10-10-2014.pdf	Form and Instruction

IC Title:

DESIGNEE FOR PATIENT PERSONAL PROPERTY

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 5802

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10118	DESIGNEE FOR PATIENT PERSONAL PROPERTY	10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 10-10-2014.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 718,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	718,000	718,000
Annual IC Time Burden (Hours)	35,900	35,900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.