Agent Orange Registry Code Sheet

OMB 2900-0376

This records symptoms, reproductive health problems and diagnoses detected during the Agent Orange Registry examination process and identifies veterans interested in knowing of health risks, research findings and new compensation policies through newsletters.

The latest form for Agent Orange Registry Code Sheet expires 2020-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form VA Form 10-9009 Agent Orange Registry Code Sheet Form
Registry exam privacy statement OMB Aug 17.docx Supplementary Document
PIA FY15 EAS (signed).pdf Supplementary Document
OMB AO Registry Justification B PDHS Registry_072617.doc Supporting Statement B
OMB AO A 2900-0376 justification 121416(3).docx Supporting Statement A
Agent Orange Registry Code Sheet Form

All Historical Document Collections

201609-2900-003 Approved with change	Reinstatement without change of a previously approved collection	2016-12-30
201211-2900-003 Approved with change	Reinstatement with change of a previously approved collection	2013-03-05
200909-2900-004 Approved without change	Extension without change of a currently approved collection	2009-12-14
200702-2900-002 Approved without change	Extension without change of a currently approved collection	2007-03-01
200403-2900-008 Approved without change	Extension without change of a currently approved collection	2004-03-19
200011-2900-009 Approved without change	Reinstatement with change of a previously approved collection	2000-11-30
199302-2900-002 Approved without change	Reinstatement with change of a previously approved collection	1993-02-26
198902-2900-001 Approved without change	Reinstatement with change of a previously approved collection	1989-02-24
198610-2900-011 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-10-01
198509-2900-004 Approved without change	Extension without change of a currently approved collection	1985-09-27
198211-2900-001 Approved without change	New collection (Request for a new OMB Control Number)	1982-11-26