Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0862 can be found here:

Documents and Forms

Document Name Document Type
Form 20-0995 Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996) Form
20-0995 DECISION REVIEW REQUEST: SUPPLEMENTAL CLAIM VA Form 20-0995-NEW AMC (508 Compliant 9-13-18).pdf www.va.gov/vaforms Form
20-0996 DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW VA Form 20-0996 (IAI) 10-25-18.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)	Agency IC Tracking Number:	VBA-AMO-YA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 2501 38 CFR 2500 38 CFR 2601

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	20-0995	DECISION REVIEW REQUEST: SUPPLEMENTAL CLAIM	VA Form 20-0995-NEW AMC (508 Compliant 9-13-18).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	20-0996	DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW	VA Form 20-0996 (IAI) 10-25-18.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58/VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records -VA	FR Citation: 83 FR 39818

Number of Respondents: 115,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	115,000	115,000
Annual IC Time Burden (Hours)	28,750	28,750
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.