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Agent Orange Registry Code Sheet
Agent Orange Registry Code Sheet
OMB: 2900-0376
IC ID: 28576
OMB.report
VA
OMB 2900-0376
ICR 201609-2900-003
IC 28576
( )
Documents and Forms
Document Name
Document Type
Form VA Form 10-9009
Agent Orange Registry Code Sheet
Form
VA Form 10-9009 Agent Orange Registry Code Sheet
VA Form 10-9009.pdf
vaww.registries.aac.va.gov
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Agent Orange Registry Code Sheet
Agency IC Tracking Number:
2900-0376
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 10-9009
Agent Orange Registry Code Sheet
VA Form 10-9009.pdf
http://vaww.registries.aac.va.gov
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
24VA10P2, Patient Medical Record – VA
FR Citation:
77 FR 65938
Number of Respondents:
20,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,000
0
0
0
20,000
0
Annual IC Time Burden (Hours)
6,667
0
0
0
6,667
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
