View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 2900-0856	ICR Reference No: 202206-2900-018
Status: Historical Active	Previous ICR Reference No: 202010-2900-011
Agency/Subagency: VA	Agency Tracking No: VBA-INS-NK
Title: Authorization to Disclose Information to a Third Party (Insurance) (VA Form 29-0975)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/09/2022
	Date Received in OIRA: 06/24/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2024	04/30/2024	04/30/2024
Responses	1,200	0	1,200
Time Burden (Hours)	100	0	100
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $6,630

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Yvette McCargo 202 461-9770 yvette.mccargo@va.gov

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