Information Collection

Request for and Consent to Release of Medical Records Protected by 38 U.S.C. 7332

IC 28501 under ICR 200108-2900-006 · OMB 2900-0260.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0260 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Request for and Consent to Release of Medical Records Protected by 38 U.S.C. 7332	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-5345				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 326,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	326,000	2,622	323,378
Annual IC Time Burden (Hours)	10,867	88	10,779
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.