Examination for Housebound Status or Permanent Need for Regular Aid and Attendance

Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0721 can be found here:

Documents and Forms

Document Name Document Type
Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance Form
21-2680 Examination for Housebound Status or Permanent Need for VA Form 21-2680 (OCRd version - Jan 2018).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Examination for Housebound Status or Permanent Need for Regular Aid and Attendance	Agency IC Tracking Number:	2900-0721

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.351 38 CFR 3.351(d) 38 CFR 3.351(d)(2) 38 CFR 3.351(c)(2) 38 CFR 4.16 38 CFR 3.326(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-2680	Examination for Housebound Status or Permanent Need for Regular Aid and Attendance	VA Form 21-2680 (OCRd version - Jan 2018).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: 14,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	7,000	7,000
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.