Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)

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Information Collection (IC) Details

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IC Title:	Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)	Agency IC Tracking Number:	2900-0721

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.351 38 CFR 3.351(c)(2) 38 CFR 4.16 38 CFR 3.326(a) 38 CFR 3.351(d) 38 CFR 3.351(d)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-2680			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 Veteran Readiness and Employment Records-VA (58VA21/22/28)	FR Citation: 87 FR 8740

Number of Respondents: 112,587	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	112,587	8,672	103,915
Annual IC Time Burden (Hours)	56,294	4,336	51,958
Annual IC Cost Burden (Dollars)	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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