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

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

OMB: 2900-0829

IC ID: 214403

Information Collection (IC) Details

View Information Collection (IC)

Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) 2900-0829
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.5 38 CFR 3.275

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

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  84 FR 4138

55,000 0
   
Individuals or Households
 
   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 55,000 0 -20,000 0 0 75,000
Annual IC Time Burden (Hours) 27,500 0 -3,750 0 0 31,250
Annual IC Cost Burden (Dollars) 818,400 0 818,400 0 0 0

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