Statement in Support of Claim for Service Connection for PTSD (VAF21-0781), Statement in Support of Claim for Service Connection for PTSD(VAF 21-0781a)

Statement in Support of Claim for Service Connection for PTSD (VA Form 21-0781), Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault (VA Form 21-0781a)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0659 can be found here:

Documents and Forms

Document Name Document Type
Form 21-0781 Statement in Support of Claim for Service Connection for PTSD (VAF21-0781), Statement in Support of Claim for Service Connection for PTSD(VAF 21-0781a) Form
21-0781 Statement in Support of Claim for Service Connection for VA Form 21-0781(03052021).pdf www.va.gov/vaforms Form
21-0781 Statement in Support of Claim for Service Connection for VA Form 21-0781(03052021).pdf www.va.gov/vaforms Form
21-0781a Statement in Support of Claim for Service Connection for VA Form 21-0781a(03052021).pdf www.va.gov/vaforms Form
21-0781a Statement in Support of Claim for Service Connection for VA Form 21-0781a(03052021).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Statement in Support of Claim for Service Connection for PTSD (VAF21-0781), Statement in Support of Claim for Service Connection for PTSD(VAF 21-0781a)	Agency IC Tracking Number:	2900-0659 VBA-COMP-NK

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.304(f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0781	Statement in Support of Claim for Service Connection for Post Traumatic Stress Disorder (PTSD)	VA Form 21-0781(03052021).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	21-0781a	Statement in Support of Claim for Service Connection for Post Traumatic Stress Disorder Secondary to Personal Assault	VA Form 21-0781a(03052021).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 84 FR 4138

Number of Respondents: 20,374	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	20,374	5,134	15,240
Annual IC Time Burden (Hours)	23,770	5,990	17,780
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.