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Statement in Support of Claim
Statement in Support of Claim
OMB: 2900-0075
IC ID: 28224
OMB.report
VA
OMB 2900-0075
ICR 200712-2900-014
IC 28224
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0075 can be found here:
2024-05-31 - Revision of a currently approved collection
2021-05-11 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form 21-4138
Statement in Support of Claim
Form
21-4138 Statement in Support of Claim
VBA-21-4138-ARE.pdf
www.va.gov/vaforms/
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Statement in Support of Claim
Agency IC Tracking Number:
2900-0075
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 3.150
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
21-4138
Statement in Support of Claim
VBA-21-4138-ARE.pdf
http://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:
752,000
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
752,000
0
0
0
0
752,000
Annual IC Time Burden (Hours)
188,000
0
0
0
0
188,000
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.