Notice of Disagreement (VA Form 21-0958)

Documents and Forms

Document Name Document Type
Form 21-0958 Notice of Disagreement (VA Form 21-0958) Form
21-0958 Notice of Disagreement VA Form 21-0958 (OMB Expiring - 1-3-18)_FINAL.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Disagreement (VA Form 21-0958)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 4.16 38 CFR 3.326 38 CFR 3.351

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0958	Notice of Disagreement	VA Form 21-0958 (OMB Expiring - 1-3-18)_FINAL.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: 199,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	199,800	55,800	144,000
Annual IC Time Burden (Hours)	49,950	-22,050	72,000
Annual IC Cost Burden (Dollars)	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.