Approved until May 31,1982 on the condition that the VA provide OMB with a list of items that will be be reduced and/or eliminated during the course of this fiscal year and will facilitate obtaining the reduced ICB allowance. In addition, the VA will revise their operating procedures to allow for the acceptance of a written request, that is not on this form, to authorize the release of medical information.
Inventory as of this Action
Requested
Previously Approved
05/31/1982
05/31/1982
11/30/1981
471,114
0
400,000
78,519
0
66,666
0
0
0
TITLE 38, U.S.C. 4132 PROVIDES FOR THE CONFIDENTIALITY OF CERTAIN MEDICAL RECORDS CONTAINING DRUG ABUSE, ALCOHOLISM OR ALCOHOL ABUSE OR SICKLE CELL ANEMIA INFORMATION. THIS FORM INSURES UNIFORM COMPLIANCE WITH THE REQUIREMENTS OF PERTINENT LAWS GOVERNING RELEASE OF DRUG, ALCOHOL OR SICKLE CELL ANEMIA INFORMATION.
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.
REQUEST FOR AND CONSENT TO RELEASE OF DRUG ABUSE, ALCOHOLISM, OR ALCOHOL ABUSE OR SICKLE CELL ANEMIA INFORMATION FROM MEDICAL RECORDS