Information Collection Request

Forms Relating to Military Service Records

ICR 202608-3095-001 · OMB 3095-0039 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form NA Form 13177 Check the Status of a Clinical & Medical Treatment Records Request Form and Instruction Modified Available
Form NA Form 13075 Questionnaire about Military Service Form and Instruction Modified Available
Form NA Form 13055 Request for Information Needed to Reconstruct Medical Data Form and Instruction Modified Available
Form NA Form 13042 Request for Information Needed to Locate Medical Records Form and Instruction Modified Available
Form NA Form 13036 Authorization for Release of Military Medical Patient Records Form and Instruction Modified Available
Form NA For 13177 Check the Status of a Clinical & Medical & Treatment Records Request Form and Instruction Unchanged Available
Explanation_June_2023.docx Supplementary Document Uploaded 2023-06-15 Available
2026_SupportingStatement_3095_0039_FINAL.pdf Supporting Statement A Uploaded 2026-08-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
32546 Forms Relating to Military Service Records Form and Instruction ModifiedCheck the Status of a Clinical & Medical Treatment Records Request
32546 Forms Relating to Military Service Records Form and Instruction ModifiedQuestionnaire about Military Service
32546 Forms Relating to Military Service Records Form and Instruction ModifiedRequest for Information Needed to Reconstruct Medical Data
32546 Forms Relating to Military Service Records Form and Instruction ModifiedRequest for Information Needed to Locate Medical Records
32546 Forms Relating to Military Service Records Form and Instruction ModifiedAuthorization for Release of Military Medical Patient Records
214198 Follow-up to Request for Clinical & Medical Treatment Records Form and Instruction UnchangedCheck the Status of a Clinical & Medical & Treatment Records Request

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
79,801 0
6,650 0
0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Follow-up to Request for Clinical & Medical Treatment Records NA For 13177
Forms Relating to Military Service Records NA Form 13055, NA Form 13075, NA Form 13177, NA Form 13042, NA Form 13036 ,   ,   ,   ,  

table that charts list of burden
  Total Request 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 79,801 0 0 -52,700 0 132,501
Annual Time Burden (Hours) 6,650 0 0 -4,392 0 11,042
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No