OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Durable Power of Attorney for Health Care and Living Will, VA Advance Directive

ICR 201704-2900-012 · OMB 2900-0556 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 10-0137 Durable Power of Attorney for Health Care and Living Will, VA Advance Directive Form and Instruction Unchanged Available
2900-0556_White Paper-Advance Directive-Spanish-English_12 19 16.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-03-07 Available
2900-0556_White Paper-Advance Directive-12 19 16.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-03-07 Available
Supporting Statement A 2900-0556_VA Form 10-0137_8.23.17.docx Supporting Statement A Uploaded 2017-08-23 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28738 Durable Power of Attorney for Health Care and Living Will, VA Advance Directive Form and Instruction Unchanged
ICR Details
2900-0556 201704-2900-012
Historical Active 201703-2900-007
VA 2900-0556
Durable Power of Attorney for Health Care and Living Will, VA Advance Directive
Extension without change of a currently approved collection   No
Regular
Approved without change 12/13/2017
Retrieve Notice of Action (NOA) 10/31/2017
  Inventory as of this Action Requested Previously Approved
12/31/2020 36 Months From Approved 12/31/2017
343,622 0 343,622
171,811 0 171,811
0 0 0
The form allows VA patients to give specific instructions about their treatment preferences in the event they are no longer competent or able to verbally express these instructions.
US Code: 38 USC 7331 Name of Law: Informed consent
  
None
Not associated with rulemaking
  82 FR 37167 08/08/2017
82 FR 48747 10/19/2017
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 343,622 343,622 0 0 0 0
Annual Time Burden (Hours) 171,811 171,811 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$6,379,342
No
    Yes
    Yes
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 [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.
10/31/2017