Information Collection

Forms Relating to Military Service Records

IC 32546 under ICR 202306-3095-005 · OMB 3095-0039.

Documents and Forms

Document Name Document Type
Form NA Form 13036 Forms Relating to Military Service Records Form and Instruction
NA Form 13036 Authorization for Release of Military Medical Patient Re NA Form 13036, Authorization for Release of Military Medical Patient RecordsFINAL.docx www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html Form and Instruction
NA Form 13036 Authorization for Release of Military Medical Patient Re NA Form 13036, Authorization for Release of Military Medical Patient RecordsFINAL.docx www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html Form and Instruction
NA Form 13042 Request for Information Needed to Locate Medical Records NA Form 13042, Request for Information Needed to Locate Medical RecordsFINAL.docx www.archives.gov/st-louis/military-personnel/na-13042-request-4-information-needed-2-locate-medical-records.pdf Form and Instruction
NA Form 13042 Request for Information Needed to Locate Medical Records NA Form 13042, Request for Information Needed to Locate Medical RecordsFINAL.docx www.archives.gov/st-louis/military-personnel/na-13042-request-4-information-needed-2-locate-medical-records.pdf Form and Instruction
NA Form 13055 Request for Information Needed to Reconstruct Medical Da NA Form 13055, Request for Information Needed to Reconstruct Medical DataFINAL.docx www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstruct-medical-data.pdf Form and Instruction
NA Form 13055 Request for Information Needed to Reconstruct Medical Da NA Form 13055, Request for Information Needed to Reconstruct Medical DataFINAL.docx www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstruct-medical-data.pdf Form and Instruction
NA Form 13075 Questionnaire about Military Service NA Form 13075, Questionnaire About Military ServiceFINAL.docx www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-about-military-service.pdf Form and Instruction
NA Form 13075 Questionnaire about Military Service NA Form 13075, Questionnaire About Military ServiceFINAL.docx www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-about-military-service.pdf Form and Instruction
NA Form 13177 Check the Status of a Clinical & Medical Treatment Recor NA13177_06_2017_3095-0039.pdf www.archives.gov/forms/st-louis/clinical-followup.html Form and Instruction
NA Form 13177 Check the Status of a Clinical & Medical Treatment Recor NA13177_06_2017_3095-0039.pdf www.archives.gov/forms/st-louis/clinical-followup.html Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Forms Relating to Military Service Records	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 36 CFR 1233.18

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA Form 13036	Authorization for Release of Military Medical Patient Records	NA Form 13036, Authorization for Release of Military Medical Patient RecordsFINAL.docx	http://www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html	Yes	No	Fillable Printable
Form and Instruction	NA Form 13042	Request for Information Needed to Locate Medical Records	NA Form 13042, Request for Information Needed to Locate Medical RecordsFINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13042-request-4-information-needed-2-locate-medical-records.pdf	Yes	No	Fillable Printable
Form and Instruction	NA Form 13055	Request for Information Needed to Reconstruct Medical Data	NA Form 13055, Request for Information Needed to Reconstruct Medical DataFINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstruct-medical-data.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NA Form 13075	Questionnaire about Military Service	NA Form 13075, Questionnaire About Military ServiceFINAL.docx	http://www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-about-military-service.pdf	Yes	Yes	Fillable Printable
Form and Instruction	NA Form 13177	Check the Status of a Clinical & Medical Treatment Records Request	NA13177_06_2017_3095-0039.pdf	https://www.archives.gov/forms/st-louis/clinical-followup.html	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title: NARA 35 Case Management and Reporting System (CMRS)	FR Citation: 78 FR 77256

Number of Respondents: 132,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	132,500	132,500
Annual IC Time Burden (Hours)	11,042	11,042
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.