Information Collection

Funeral Arrangements Request Form

IC 210686 under ICR 201711-2900-003 · OMB 2900-0080.

Documents and Forms

Document Name Document Type
Form 10-2065 Funeral Arrangements Request Form Form
10-2065 FUNERAL ARRANGEMENTS VA Form 10-2065 (Funeral Arrangements)_new statement.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Funeral Arrangements Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	10-2065	FUNERAL ARRANGEMENTS	VA Form 10-2065 (Funeral Arrangements)_new statement.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,213	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	22,213	22,213
Annual IC Time Burden (Hours)	3,702	3,702
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.