Information Collection

Regulation for Submission of Evidence - Title 38 CFR 17.101(a)(4)

IC 28850 under ICR 201708-2900-035 · OMB 2900-0606.

Documents and Forms

Document Name Document Type
38 CFR Part 17_20140318.pdf Other-Regulation

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Regulation for Submission of Evidence - Title 38 CFR 17.101(a)(4)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17.101(a)(4)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Regulation			38 CFR Part 17_20140318.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 24VA19, Patient Medical Records-VA	FR Citation: 69 FR 18428

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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