VA Advance Directive - Durable Power of Attorney for Health Care and Living Will [AQ97]

ICR 202006-2900-009

OMB: 2900-0556

Federal Form Document

IC Document Collections
ICR Details
2900-0556 202006-2900-009
Active 202005-2900-003
VA 2900-0556
VA Advance Directive - Durable Power of Attorney for Health Care and Living Will [AQ97]
Revision of a currently approved collection   No
Emergency 07/01/2020
Approved without change 07/07/2020
Retrieve Notice of Action (NOA) 06/30/2020
Emergency approval is granted. VA shall proceed with the normal clearance process in order to avoid a lapse in OMB approval.
  Inventory as of this Action Requested Previously Approved
01/31/2021 6 Months From Approved 12/31/2020
343,922 0 300
171,861 0 50
0 0 0

Section 7331 of title 38, United States Code (U.S.C.), requires, in relevant part, that the Secretary of Veterans Affairs, upon the recommendation of the Under Secretary for Health, prescribe regulations to ensure, to the maximum extent practicable, that all VA patient care be carried out only with the full and informed consent of the patient, or in appropriate cases, a representative thereof. Based on VA’s interpretation of this statute and our mandate in 38 U.S.C. 7301(b) to provide a complete medical and hospital service, we recognize that patients with decision-making capacity have the right to state their treatment preferences in a VA or other valid advance directive. The VA advance directive form (both English and Spanish language versions) is VA Form 10-0137. These forms have a current OMB Paperwork Reduction Act (PRA) clearance under OMB Control Number 2900-0556.
This request for an emergency PRA clearance applies to changes made to the Witnesses Section of VA Form 10-0137 Advance Directive (both English and Spanish language versions). This information collection is noticed in the interim final rule associated with RIN 2900-AQ97. Emergency clearance is requested because AQ97 changed from a proposed rule to an interim final rule that will soon be cleared for publication in the Federal Register. The use of regular OMB clearance procedures will not allow for coordination of the PRA clearance with publication of the rule.

US Code: 38 USC 7331 Name of Law: Informed consent

2900-AQ97 Final or interim final rulemaking 85 FR 31690 05/27/2020


  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 343,922 300 0 343,622 0 0
Annual Time Burden (Hours) 171,861 50 0 171,811 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Changing Regulations
The burden for this information collection has not changed for VA Form 10-0137; however, there was an addition previously approved by OMB for an estimated 300 Close Friend Statements to be collected annually as part of 2900-0556.

Frances O'Donnell 703 405-2449 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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