View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Authorization to Disclose Information to the VA, General Release of Medical Provider Information to the VA (VA Forms 21-4142 and 21-4142a)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21-4142 https://www.va.gov/vaforms/ Yes No Fillable Printable
Form 21-4142a https://www.va.gov/vaforms/ Yes No Fillable Printable

General Government Legislative Functions

 

132,400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 132,400 0 132,400 0 0 0
Annual IC Time Burden (Hours) 11,033 0 11,033 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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