Lay/Witness Statement (VA Form 21-10210)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0881 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-10210 Lay/Witness Statement (VA Form 21-10210) Form
VA Form 21-10210 Lay/Witness Statement 21-10210(7-23-20).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Lay/Witness Statement (VA Form 21-10210)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.159 38 CFR 3.303

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-10210	Lay/Witness Statement	21-10210(7-23-20).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension and Fiduciary, Vocational Rehabilitation and Employment Services	FR Citation: 84 FR 4138

Number of Respondents: 100,000	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
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	16,667	16,667
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.