Information Collection

VA Form 10-0137

IC 242471 under ICR 202312-2900-003 · OMB 2900-0556.

Documents and Forms

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_English_OMB passback_rev Apr 2024.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_Spanish-English_OMB passback_rev Apr 2024.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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_English_OMB passback_rev Apr 2024.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_Spanish-English_OMB passback_rev Apr 2024.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 %

	Approved	Previously Approved
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

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.