Advanced Directive - Living Will and Durable Power of Attorney

ICR 200804-2900-023 · OMB 2900-0556 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0556 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form VA Form 10-0137 Advanced Directive - Living Will and Durable Power of Attorney	Form	Modified	Available
2900-0556 justification.DOC	Supporting Statement A	Uploaded 2008-07-09	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
28738	Advanced Directive - Living Will and Durable Power of Attorney	Form	Modified

ICR Details

OMB Control No: 2900-0556	ICR Reference No: 200804-2900-023
Status: Historical Active	Previous ICR Reference No: 200610-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0556
Title: Advanced Directive - Living Will and Durable Power of Attorney
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/05/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/25/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2011	36 Months From Approved	11/30/2008
Responses	343,622	0	256,253
Time Burden (Hours)	171,811	0	128,127
Cost Burden (Dollars)	0	0	0

Abstract: The form 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.

Authorizing Statute(s): US Code: 38 USC 7331 Name of Law: Informed consent

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 94	05/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 142	07/23/2008
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Advanced Directive - Living Will and Durable Power of Attorney	VA Form 10-0137	VA ADVANCE DIRECTIVE:DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND LIVING WILL

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	343,622	256,253	87,369
Annual Time Burden (Hours)	171,811	128,127	43,684
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: All changes are attributable to an adjustment. The number of veterans who complete VA advance directive form has increased as attention is focused on this subject and the aging population takes longer to complete the form.

Annual Cost to Federal Government: $6,379,342

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Denise McLamb 202-565-8374 [email protected]

Common Form ICR: No