OMB approves
this form for use under the condition that the VA immediately
incorporates the disclosure statements mandated by the Paperwork
Reduction Act of 1995. For the public record, the VA must submit to
OMB the revised forms/intstructions.
Inventory as of this Action
Requested
Previously Approved
03/31/2003
03/31/2003
244
0
0
61
0
0
0
0
0
This form letter is used to request
medical information from the insured's doctor or hospital in
connection with disability insurance benefits (38 U.S.C. 1912,
1915, 1942, and 1948).
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.