Information Collection

Statement of Accredited Representative in Appealed Case

IC 28158 under ICR 200608-2900-013 · OMB 2900-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0042 can be found here:

Documents and Forms

Document Name Document Type
Form 646 Statement of Accredited Representative in Appealed Case Form
646 Statement of Accredited Representative Appealed Case 2900-0042 VA Form 646.pdf www.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Accredited Representative in Appealed Case	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 20.600

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	646	Statement of Accredited Representative Appealed Case	2900-0042 VA Form 646.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records
Title: Compensation, Pension, Education and Rehabiitation Records 58VA21/22	FR Citation: 67 FR 66457

Number of Respondents: 30,462	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,462	2,022	28,440
Annual IC Time Burden (Hours)	30,462	2,022	28,440
Annual IC Cost Burden (Dollars)	0	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.