OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Advanced Directive - Living Will and Durable Power of Attorney

ICR 200610-2900-007 · OMB 2900-0556 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 10-0137 Advanced Directive - Living Will and Durable Power of Attorney Form Modified Available
2900-0556 83c Justification.doc Justification for No Material/Nonsubstantive Change Uploaded 2006-10-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
28738 Advanced Directive - Living Will and Durable Power of Attorney Form Modified
ICR Details
2900-0556 200610-2900-007
Historical Active 200509-2900-001
VA
Advanced Directive - Living Will and Durable Power of Attorney
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/15/2006
Retrieve Notice of Action (NOA) 10/18/2006
  Inventory as of this Action Requested Previously Approved
11/30/2008 11/30/2008 11/30/2008
256,253 0 256,253
128,127 0 128,127
0 0 0
This is used exclusively by VA patients to given specific instructions about their treatment preferences in the event they are no longer competent or able to verbally express these instructions. This voluntary information is collected at admission to the medical center and then filed into the patient's medical record.
None
None
Not associated with rulemaking
No
  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 256,253 256,253 0 0 0 0
Annual Time Burden (Hours) 128,127 128,127 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Denise McLamb 202-565-8374 [email protected]
  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.
10/18/2006