The Paperwork Reduction Act of 1995 requires us to notify you that this
information collection is in accordance with the clearance requirements
of section 3507 of the Paperwork Reduction Act of 1995. We may not
conduct or sponsor, and you are not required to respond to, a collection
of information unless it displays a valid OMB number. We anticipate that
the time expended by all individuals who must complete this form will
average ten (10) minutes. This includes the time it will take to read
instructions, gather the necessary facts and fill out the form. This
collection of information is intended to fulfill the need identified by
the Department of Veterans Affairs (VA) to categorize your question,
complaint, compliment, or suggestion and collect the necessary
information to respond to it. Results will be used to automatically
route your inquiry to the appropriate person in the VA, which will help
ensure that you receive a response in a timely manner. Use of this form
is voluntary and failure to participate will have no adverse effect of
benefits to which you might otherwise be entitled.
