OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet

ICR 200804-2900-021 · OMB 2900-0720 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21-0773 Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet Form New Repair queued
VA Form 21-0773 justification.doc Supporting Statement A Uploaded 2008-09-02 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
184617 Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet Form New
ICR Details
2900-0720 200804-2900-021
Historical Active
VA
Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/08/2009
Retrieve Notice of Action (NOA) 09/11/2008
  Inventory as of this Action Requested Previously Approved
01/31/2012 36 Months From Approved
153 0 0
77 0 0
0 0 0
This form will serve as a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness.
US Code: 5 USC 552a Name of Law: Records maintained on individuals
  
None
Not associated with rulemaking
  73 FR 126 06/30/2008
73 FR 177 09/11/2008
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 153 0 0 153 0 0
Annual Time Burden (Hours) 77 0 0 77 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection.
$5,288
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.
09/11/2008