Advanced Directive - Living Will and Durable Power of Attorney

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0556 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-0137 Advanced Directive - Living Will and Durable Power of Attorney Form
VA Form 10-0137 VA ADVANCE DIRECTIVE:DURABLE POWER OF ATTORNEY FOR HEALT VA Form 10-0137.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Advanced Directive - Living Will and Durable Power of Attorney	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	VA Form 10-0137	VA ADVANCE DIRECTIVE:DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND LIVING WILL	VA Form 10-0137.pdf		No		Paper Only

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	343,622	87,369	256,253
Annual IC Time Burden (Hours)	171,811	43,684	128,127
Annual IC Cost Burden (Dollars)	0	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.