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Supplemental Physical Examination Report
Supplemental Physical Examination Report, Attending Physician's Statement, Supplemental Physical Examination Report (Diabetes - Physician's Report)
OMB: 2900-0324
IC ID: 28541
OMB.report
VA
OMB 2900-0324
ICR 200804-2900-005
IC 28541
( )
Documents and Forms
Document Name
Document Type
Form VA Form 29-8146
Supplemental Physical Examination Report
Form
VA Form 29-8146 Supplemental Physical Examination Report
29-8146.pdf
www.va.gov/vaforms
Form
VA Form 29-8160 Supplemental Physical Examination Report (Diabetes - Phy
29-8160.PDF
www.va.gov/vaforms
Form
VA Form 29-8158 Attending Physician's Statement
29-8158.pdf
www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Supplemental Physical Examination Report
Agency IC Tracking Number:
2900-0324
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 8.5
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 29-8146
Supplemental Physical Examination Report
29-8146.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 29-8160
Supplemental Physical Examination Report (Diabetes - Physician's Report)
29-8160.PDF
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 29-8158
Attending Physician's Statement
29-8158.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Legislative Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,440
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
1,440
0
0
0
0
1,440
Annual IC Time Burden (Hours)
1,080
0
0
0
0
1,080
Annual IC Cost Burden (Dollars)
0
0
0
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.