VA Form 10-0137

VA Advance Directive - Durable Power of Attorney for Health Care and Living Will [AQ97]

⚠️ Notice: This information collection may be referencing outdated material.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 10-0137 VA Form 10-0137 Form and Instruction
10-0137 VA Advance Directive - Durable Power of Attorney for Hea VA Form 10-0137_Advance Directive_revised June 2020.pdf Form and Instruction
10-0137 VA Advance Directive - Durable Power of Atttorney for He VA Form 10-0137_Spanish-English_Advance Directive_revised June 2020.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	VA Form 10-0137	Agency IC Tracking Number:	2900-0556

Is this a Common Form? No		IC Status: New

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 and Instruction	10-0137	VA Advance Directive - Durable Power of Attorney for Health Care and Living Will	VA Form 10-0137_Advance Directive_revised June 2020.pdf		Yes	No	Fillable Printable
Form and Instruction	10-0137	VA Advance Directive - Durable Power of Atttorney for Health Care and Living WIll (English-Spanish)	VA Form 10-0137_Spanish-English_Advance Directive_revised June 2020.pdf		Yes	No	Fillable Printable

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	343,622	343,622
Annual IC Time Burden (Hours)	171,811	171,811
Annual IC Cost Burden (Dollars)	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.