REPS Annual Eligibility Report (VA Form 21P-8941)

OMB 2900-0405

VA Form 21P-8941 (formerly VA Form 21-8941) is used to gather information that is necessary to determine a REPS beneficiary's continued entitlement to REPS benefits. Without this information, VA would be unable to properly authorize benefits, and overpayments would result.

The latest form for REPS Annual Eligibility Report (VA Form 21P-8941) expires 2021-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form VA Form 21P-8941 REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941) Form
60-Day FRN - 2900-0405 (2024).pdf Supplementary Document
30-Day FRN - 2900-0405 (2024).pdf Supplementary Document
2900-0405 Supporting Statement (21P-8941).docx Supporting Statement A
REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941) Form

All Historical Document Collections

202401-2900-002 Approved with change	Extension without change of a currently approved collection	2024-03-21
202102-2900-008 Approved without change	Reinstatement without change of a previously approved collection	2021-04-23
201708-2900-016 Approved without change	Extension without change of a currently approved collection	2017-12-27
201404-2900-019 Approved without change	Revision of a currently approved collection	2014-09-25
201104-2900-026 Approved without change	Extension without change of a currently approved collection	2011-08-25
200804-2900-018 Approved without change	Extension without change of a currently approved collection	2008-07-18
200507-2900-001 Approved without change	Extension without change of a currently approved collection	2005-07-01
200205-2900-003 Approved without change	Extension without change of a currently approved collection	2002-05-08
199907-2900-010 Approved without change	Reinstatement without change of a previously approved collection	1999-07-22
199508-2900-044 Approved without change	Extension without change of a currently approved collection	1995-08-28
199212-2900-003 Approved without change	Revision of a currently approved collection	1992-12-02
198910-2900-003 Approved without change	Reinstatement with change of a previously approved collection	1989-10-13
198904-2900-024 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-06
198709-2900-033 Approved without change	Reinstatement with change of a previously approved collection	1987-09-17
198408-2900-027 Approved without change	Revision of a currently approved collection	1984-08-23
198312-2900-023 Approved without change	New collection (Request for a new OMB Control Number)	1983-12-28