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

View Information Collection (IC)

Authorization to Disclose Information to VA (VA Form 21-4142), General Release of Medical Provider Information to VA (VA Form 21-4142a)
 
No Modified
 
Voluntary
 
45 CFR 160 45 CFR 164 38 CFR 2

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

General Government Legislative Functions

58VA21/22/28, Compensation, Pension, Education, Veteran Readiness and Employment Records - VA  87 FR 8740

440,246 0
   
Individuals or Households
 
   50 %

  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 440,246 0 312,849 0 0 127,397
Annual IC Time Burden (Hours) 36,687 0 26,071 0 0 10,616
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.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.