Back (Thoracolumbar Spine)Conditions Disability Benefits Questionnaire (21-0960M-14)

ICR 201612-2900-008

OMB: 2900-0808

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
2900-0808 201612-2900-008
Historical Inactive 201304-2900-031
VA VBA-COMP-YM
Back (Thoracolumbar Spine)Conditions Disability Benefits Questionnaire (21-0960M-14)
Extension without change of a currently approved collection   Yes
Regular
Withdrawn and continue 09/29/2017
Retrieve Notice of Action (NOA) 04/07/2017
VA withdraws this collection to make a technical correction to the way it was submitted.
  Inventory as of this Action Requested Previously Approved
04/30/2017 36 Months From Approved 12/31/2017
50,000 0 50,000
37,500 0 37,500
0 0 0

The form will be used to gather necessary information from a claimant's treating physician regarding the results of medical examinations. VA will gather medical information related to the claimant that is necessary to adjudicate the claim for VA disability benefits.

US Code: 38 USC 501(a) Name of Law: Rules and Regulations
  
None

Not associated with rulemaking

  81 FR 96202 12/29/2016
82 FR 12913 03/07/2017
No

No
No

$4,354,350
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov

  Yes
 
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/07/2017


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