VA is reminded to include the OMB Control Number and required legal statement indicating that an individual may not be required to respond to an information request that does not display a currently valid OMB control number.
Inventory as of this Action
Requested
Previously Approved
03/31/2016
36 Months From Approved
03/31/2013
1,311,000
0
1,300,000
60,550
0
65,000
0
0
0
These forms are used to obtain written patient consent for release of medical records to individuals and third parties when the information is considered protected, the information is covered by confidentiality, privacy or HIPAA statutes, or the individual requests copies of their own records.
US Code:
38 USC 5701
Name of Law: Confidential nature of claims
US Code:
38 USC 7332
Name of Law: Confidentiality of certain medical records
VA Forms 10-0525A and 10-0485 are new forms that contribute to the Program Change and increase in burden hours. Also, the time to complete VA Form 10-5345 was reduced from 3 minutes to 2 minutes.
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.
Form 10-5345a Request for and Authorization to Release Medical Records or Health Information, etc
2900-0260_justification (v6.1).docx
Request for and Authorization to Release Medical Records or Health Information, etc