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Federal forms, ICRs, and supporting documents

Information Collection Request

Request for and Consent to Release of Information from Claimant's Records

ICR 200210-2900-010 · OMB 2900-0025 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
42177 Request for and Consent to Release of Information from Claimant's Records Form Migrated
ICR Details
2900-0025 200210-2900-010
Historical Active 200008-2900-001
VA
Request for and Consent to Release of Information from Claimant's Records
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/16/2002
Retrieve Notice of Action (NOA) 10/16/2002
  Inventory as of this Action Requested Previously Approved
10/31/2002 10/31/2002 10/31/2003
151,000 0 151,000
18,875 0 18,875
0 0 0
The form is completed by veterans or beneficiaries to provide the VA with a written consent to release records or information to a third party.
None
None
No
1
IC Title Form No. Form Name
Request for and Consent to Release of Information from Claimant's Records 3288
  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 151,000 151,000 0 0 0 0
Annual Time Burden (Hours) 18,875 18,875 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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.
10/16/2002