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Close Personal Friend Statement of Relationship to Veteran
VA Advance Directive - Durable Power of Attorney for Health Care and Living Will (VA Form 10-0137)
OMB: 2900-0556
IC ID: 241723
OMB.report
VA
OMB 2900-0556
ICR 202010-2900-001
IC 241723
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0556 can be found here:
2024-02-26 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Close Personal Friend Statement of Relationship to Veteran
Agency IC Tracking Number:
2900-0556
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
38 CFR 17.32
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
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
300
0
0
0
300
0
Annual IC Time Burden (Hours)
50
0
0
0
50
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.