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Income Verification
Income Verification
OMB: 2900-0867
IC ID: 221774
OMB.report
VA
OMB 2900-0867
ICR 201606-2900-001
IC 221774
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0867 can be found here:
2022-03-15 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form 200-1A
Income Verification
Form
Word Doc Future Checklist Encl 4-.doc
Other-Checklist
200-1A Income Verification Response
FUTURE Word Version - 200-1A - VETERAN - INCOME VERIFICATION RESPONSE-OMB Encl1.doc
Form
220-1 Spouse - Income Verification Response
Word Doc Future 220-1 SPOUSE 06 24 2016-OMB Encl 2.doc
Form
340-1 Declaration of Representative
Word Doc Future 340-1 Encl 3-.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Income Verification
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
200-1A
Income Verification Response
FUTURE Word Version - 200-1A - VETERAN - INCOME VERIFICATION RESPONSE-OMB Encl1.doc
No
Paper Only
Form
220-1
Spouse - Income Verification Response
Word Doc Future 220-1 SPOUSE 06 24 2016-OMB Encl 2.doc
No
Paper Only
Form
340-1
Declaration of Representative
Word Doc Future 340-1 Encl 3-.doc
No
Paper Only
Other-Checklist
Word Doc Future Checklist Encl 4-.doc
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
273,441
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
273,441
0
273,441
0
0
0
Annual IC Time Burden (Hours)
119,993
0
119,993
0
0
0
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.