Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s) (VA Form 21-0781)

Documents and Forms

Document Name Document Type
Form VA Form 21-0781 Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s) (VA Form 21-0781) Form
VA Form 21-0781 Statement in Support of Claimed Mental Health Disorder(s 21-0781(2-14-24).pdf www.va.gov/vaforms Form
VA Form 21-0781 Statement in Support of Claimed Mental Health Disorder(s 21-0781(3-28-24).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s) (VA Form 21-0781)	Agency IC Tracking Number:	2900-0659

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	VA Form 21-0781	Statement in Support of Claimed Mental Health Disorder(s) Due to an In Service Traumatic Event(s)	21-0781(3-28-24).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: 89 FR 86220

Number of Respondents: 116,581	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	116,581	96,207	20,374
Annual IC Time Burden (Hours)	87,436	63,666	23,770
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.