Request for Nursing Home Information in Connection with Claim for Aid and Attendance

Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)

OMB: 2900-0652

IC ID: 28927

Information Collection (IC) Details

View Information Collection (IC)

Request for Nursing Home Information in Connection with Claim for Aid and Attendance
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.351 38 CFR 3.551

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21-0779 Request for Nursing Home Information in Connection with Claim for Aid and Attendance VA Form 21-077.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  84 FR 66707

61,125 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 61,125 0 0 0 0 61,125
Annual IC Time Burden (Hours) 10,188 0 0 0 0 10,188
Annual IC Cost Burden (Dollars) 201,519 0 0 0 0 201,519

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