OMB83-C_followuptoNAForms13036&others

OMB83-C_followuptoNAForms13036&others.docx

Forms Relating to Military Service Records

OMB83-C_followuptoNAForms13036&others

OMB: 3095-0039

Document [docx]
Download: docx | pdf

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/Subagency


National Archives and Records Administration

OMB Control Number


3 0 9 5 – 0 0 3 9

Enter only items that change

Current record New record

Agency form number(s)

NA Form 13177



Annual reporting and recordkeeping hour burden


Number of respondents


Total annual respondents


Percent of these responses

collected electronically


Total annual hours

Difference

Explanation of difference

Program change

Adjustment



     

     

     

     


100%


     %

     

     


     

     

     


     

Annual reporting and recordkeeping cost burden (in thousands of dollars)


Total annualized Capital/Startup costs


Total annual costs (O&M)


Total annualized cost requested


Difference


Explanation of difference



Program change


Adjustment




     

     

     

     

     

     


     


     


     

Other changes**Note: This form would be a follow-up NA Form 13036, Authorization for Release of Military Medical Patient Records; NA Form 13042, Request for Information Needed to Locate Medical Records; NA Form 13055, Request for Information Needed to Reconstruct Medical Data; and NA Form 13075, Questionnaire about Military Service, allowing customers to receive a status update for existing requests.

Signature of Senior Official or Designee:



Executive for Information Services/CIO

Date:

For OIRA Use

** This form cannot be used to extend an expiration date.

OMB FORM 83–C, 10/95

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePAPERWORK REDUCTION ACT
AuthorNARAuser
File Modified0000-00-00
File Created2021-01-25

© 2024 OMB.report | Privacy Policy