Alternate Signer Certification

Alternate Signer Certification (VA Form 21-0972)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0849 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0972 Alternate Signer Certification Form
VA Form 21-0972 Alternate Signer Certification 21-0972(3-16-16).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Alternate Signer Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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 21-0972	Alternate Signer Certification	21-0972(3-16-16).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	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.