Information Collection

Funeral Arrangements Request Form

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-2065 FUNERAL ARRANGEMENTS Funeral Arrangements Request Form	Form
10-2065 FUNERAL ARRANGEMENTS VA Form 10-2065 (Funeral Arrangements)_new statement.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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	10-2065				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 %

table that charts list of burden
	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

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].