Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

Documents and Forms

Document Name Document Type
Form 21P-0969 Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) Form and Instruction
21P-0969 Income and Asset Statement in Support of Claim for Pensi VA Form 21P-0969 (Revisions 6-16-23).pdf www.vba.va.gov/pubs/forms/VBA-21P-0969-ARE.pdf Form and Instruction
21P-0969 Income and Asset Statement in Support of Claim for Pensi VA Form 21P-0969 (Revisions 6-16-23).pdf www.vba.va.gov/pubs/forms/VBA-21P-0969-ARE.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)	Agency IC Tracking Number:	2900-0829

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.5 38 CFR 3.275

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	21P-0969	Income and Asset Statement in Support of Claim for Pension or Parent's Dependency and Indemnity Compensation (D.I.C.)	VA Form 21P-0969 (Revisions 6-16-23).pdf	https://www.vba.va.gov/pubs/forms/VBA-21P-0969-ARE.pdf	Yes	No	Printable Only

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: 55,000	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	Previously Approved
Annual Number of Responses for this IC	55,000	-20,000	75,000
Annual IC Time Burden (Hours)	27,500	-3,750	31,250
Annual IC Cost Burden (Dollars)	818,400	818,400	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.