Information Collection

Former POW Medical History

IC 28634 under ICR 201504-2900-009 · OMB 2900-0427.

Documents and Forms

Document Name Document Type
Form 10-0048 Former POW Medical History Form
10-0048 Former POW Medical History FPOW 10-0048-fill2.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-0048-fill.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Former POW Medical History	Agency IC Tracking Number:	2900-0427

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0048	Former POW Medical History	FPOW 10-0048-fill2.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-0048-fill.pdf	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.