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Certificate as to Assets
Certificate as to Assets (21P-4709)
OMB: 2900-0107
IC ID: 28292
OMB.report
VA
OMB 2900-0107
ICR 201404-2900-009
IC 28292
( )
Documents and Forms
Document Name
Document Type
Form VA Form 21-4709
Certificate as to Assets
Form
VA Form 21-4709 Certificate As To Assets
21P-4709.pdf
www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Certificate as to Assets
Agency IC Tracking Number:
2900-0107
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 13.100
38 CFR 13.104
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 21-4709
Certificate As To Assets
21P-4709.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:
4,316
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
4,316
0
0
0
0
4,316
Annual IC Time Burden (Hours)
863
0
0
0
0
863
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.
