Information Collection

Forms Relating to Military Service Records

IC 32546 under ICR 202608-3095-001 · OMB 3095-0039.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NA Form 13036 Authorization for Release of Military Medical Patient Records Forms Relating to Military Service Records	Form and Instruction
Form NA Form 13042 Request for Information Needed to Locate Medical Records Forms Relating to Military Service Records	Form and Instruction
Form NA Form 13055 Request for Information Needed to Reconstruct Medical Data Forms Relating to Military Service Records	Form and Instruction
Form NA Form 13075 Questionnaire about Military Service Forms Relating to Military Service Records	Form and Instruction
Form NA Form 13177 Check the Status of a Clinical & Medical Treatment Records Request 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 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 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

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:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA Form 13036	http://www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html	Yes	No	Fillable Printable
Form and Instruction	NA Form 13042	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	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	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	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: 79,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	79,800	-52,700	132,500
Annual IC Time Burden (Hours)	6,650	-4,392	11,042
Annual IC Cost Burden (Dollars)	0	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.

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