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

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

Documents and Forms

Document Name Document Type
Form 21-0960M-14 Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (21-0960M-14) Form
21-0960M-14 Back (Thoracolumbar Spine) Conditions Disability Benefit VA Form 21-0960M-14 (508 Conformant 1-19-17).pdf www.va.gov/vaforms/ Form

Information Collection (IC) Details

IC Title:	Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (21-0960M-14)	Agency IC Tracking Number:	2900-NEW VBA-COMP-DB

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.351(e) 38 CFR 3.326 38 CFR 3.351(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0960M-14	Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire	VA Form 21-0960M-14 (508 Conformant 1-19-17).pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 74 FR 29275

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	37,500	37,500
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.