Former POW Medical History

ICR 201504-2900-009

OMB: 2900-0427

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2015-11-17
Supplementary Document
2006-10-05
IC Document Collections
IC ID
Document
Title
Status
28634 Modified
ICR Details
2900-0427 201504-2900-009
Historical Active 201207-2900-008
VA 2900-0427
Former POW Medical History
Revision of a currently approved collection   No
Regular
Approved without change 02/05/2016
Retrieve Notice of Action (NOA) 11/19/2015
  Inventory as of this Action Requested Previously Approved
02/28/2019 36 Months From Approved 02/29/2016
75 0 75
113 0 113
0 0 0

Used by VA physicians during a medical exam to assess the health care, disability, compensation and rehabilitation needs of Former Prisoners of War. Data collected because of PL 97-37, which liberalized eligibility requirements and extended existing benefits.

PL: Pub.L. 97 - 37 221 Name of Law: Former Prisoner of War Benefits Act of 1981
  
None

Not associated with rulemaking

  80 FR 39837 07/10/2015
80 FR 63875 10/21/2015
No

1
IC Title Form No. Form Name
Former POW Medical History 10-0048 Former POW Medical History

  Total Approved 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 75 75 0 0 0 0
Annual Time Burden (Hours) 113 113 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$13,891
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@va.gov

  No

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.
11/19/2015


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