Neck (Cervical Spine) Conditions Disability Benefits Questionnaire (VA Form 21-0960M-13)

Documents and Forms

Document Name Document Type
Form VA Form 21-0960M-1 Neck (Cervical Spine) Conditions Disability Benefits Questionnaire (VA Form 21-0960M-13) Form
VA Form 21-0960M-1 Neck (Cervical Spine) Conditions Disability Benefits Que VBA-21-0960M-13-ARE.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Neck (Cervical Spine) Conditions Disability Benefits Questionnaire (VA Form 21-0960M-13)	Agency IC Tracking Number:	VBA-COMP-DJ

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0960M-13	Neck (Cervical Spine) Conditions Disability Benefits Questionnaire	VBA-21-0960M-13-ARE.pdf	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: 75 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	Change Due to Potential Violation of the PRA
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
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.