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Income Verification
Income Verification (21-0161a)
OMB: 2900-0518
IC ID: 28700
OMB.report
VA
OMB 2900-0518
ICR 201508-2900-014
IC 28700
( )
Documents and Forms
Document Name
Document Type
Form VA Form 21-0161a
Income Verification
Form
VA Form 21-0161a INCOME VERIFICATION
VA Form 21-0161a (10-1-15) 508 Approved 10-9-15.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Income Verification
Agency IC Tracking Number:
2900-0518
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 21-0161a
INCOME VERIFICATION
VA Form 21-0161a (10-1-15) 508 Approved 10-9-15.pdf
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Survivor Compensation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
30,000
0
0
0
0
30,000
Annual IC Time Burden (Hours)
15,000
0
0
0
0
15,000
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.
