Information Collection

VA Form 10-0137

IC 242471 under ICR 202010-2900-001 · OMB 2900-0556.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0556 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0137 VA Form 10-0137	Form and Instruction
10-0137 VA Advance Directive - Durable Power of Attorney for Hea VA Form 10-0137_VA Advance Directive_updated Oct 2020.pdf	Form and Instruction
10-0137 VA Advance Directive - Durable Power of Attorney for Hea VA Form 10-0137_VA Advance Directive_updated Oct 2020.pdf	Form and Instruction
10-0137 VA Advance Directive - Durable Power of Atttorney for He VA Form 10-0137_VA Advance Directive_Spanish-English_updated Oct 2020.pdf	Form and Instruction
10-0137 VA Advance Directive - Durable Power of Atttorney for He VA Form 10-0137_VA Advance Directive_Spanish-English_updated Oct 2020.pdf	Form and Instruction

IC Title:

VA Form 10-0137

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-0137	VA Advance Directive - Durable Power of Attorney for Health Care and Living Will	VA Form 10-0137_VA Advance Directive_updated Oct 2020.pdf		Yes	No	Fillable Printable
Form and Instruction	10-0137	VA Advance Directive - Durable Power of Atttorney for Health Care and Living WIll (English-Spanish)	VA Form 10-0137_VA Advance Directive_Spanish-English_updated Oct 2020.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 343,622

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	343,622	343,622
Annual IC Time Burden (Hours)	171,811	171,811
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.