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Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)
OMB: 2900-0094
IC ID: 28260
OMB.report
VA
OMB 2900-0094
ICR 202404-2900-004
IC 28260
( )
Documents and Forms
Document Name
Document Type
Form 21-4169
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)
Form
21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535
VBA-21-4169-ARE 4-25-24.pdf
www.va.gov/vaforms
Form
21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535
VBA-21-4169-ARE 7-22-24.pdf
www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)
Agency IC Tracking Number:
2900-0094
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 3.40
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
21-4169
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)
VBA-21-4169-ARE 7-22-24.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Legislative Functions
Privacy Act System of Records
Title:
Compensation, Pension, Education, and Veteran Readiness and Employment Records-VA (58VA21/22/28)
FR Citation:
87 FR 8740
Number of Respondents:
849
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
849
0
-151
0
0
1,000
Annual IC Time Burden (Hours)
212
0
-38
0
0
250
Annual IC Cost Burden (Dollars)
0
0
0
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.