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Get Form Omb No 2900 0567

Form Approved OMB No. 2900-0567 Respondent Burden 2 Minutes Department of Veterans Affairs PRESIDENTIAL MEMORIAL CERTIFICATE REQUEST FORM RESPONDENT BURDEN Public reporting burden for this collection ofinfonnation is estimated to average two minutes per response. Statutory authority for the Presidential Memorial Certificate PMC Program is 38 USC 112. The information requested is approved under OMB Control Number 2900-0567 and is necessary to allow eligible recipients next of kin other relatives or friends to request additional certificates and/or replacement or correct certificates on receipt of the original PMC The National Cemetery Administration does not give sell or transfer any personal information outside of the agency. VA may not conduct or sponsor and you are not required to respond to this collection ofinfonnation unless it displays a valid OMB Control Number. Responding to this collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of information including suggestions for reducing this burden to VA Clearance Officer 005U2 810 Vermont Avenue NW Washington DC 20420. SEND COMMENTS ONLY. Please do not send applications jar benefits to this address. INSTRUCTIONS When inserting the veterans name below DO NOT include nickname military rank or civilian title. Complete a new V A Form 40-0247 for each additional name and/or mailing address. NAME OF VETERAN NAME AND MAILING ADDRESS OF PERSON REQUESTING CERTIFICATE NUMBER OF CERTIFICATES REQUESTED HOME OR WORKTELEPHONE NUMBER SIGNATUREOF REQUESTOR Include area code and do not insert spaces between numbers RETURN COMPLETED FORM ALONG WITH A COPY OF THE DISCHARGE DOCUMENTS TO Presidential Memorial Certificates 41A 1C National Cemetery Administration 5109 Russell Road Quantico VA 22134-3903 YCJ o R 40-0247 Fax To 1 800 455-7143 Or Adobe LiveCycie Designer 7. Statutory authority for the Presidential Memorial Certificate PMC Program is 38 USC 112. The information requested is approved under OMB Control Number 2900-0567 and is necessary to allow eligible recipients next of kin other relatives or friends to request additional certificates and/or replacement or correct certificates on receipt of the original PMC The National Cemetery Administration does not give sell or transfer any personal information outside of the agency. VA may not conduct or sponsor and you are not required to respond to this collection ofinfonnation unless it displays a valid OMB Control Number. VA may not conduct or sponsor and you are not required to respond to this collection ofinfonnation unless it displays a valid OMB Control Number. Responding to this collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of information including suggestions for reducing this burden to VA Clearance Officer 005U2 810 Vermont Avenue NW Washington DC 20420. Responding to this collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of information including suggestions for reducing this burden to VA Clearance Officer 005U2 810 Vermont Avenue NW Washington DC 20420. SEND COMMENTS ONLY. Please do not send applications jar benefits to this address. INSTRUCTIONS When inserting the veterans name below DO NOT include nickname military rank or civilian title.

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