Eligibility Verification Report

ELIGIBILITY VERIFICATION REPORT

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0101 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	ELIGIBILITY VERIFICATION REPORT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21-8913	No	No
Form	21-8918	No	No
Form	21-8916	No	No
Form	21-8914	No	No
Form	21-8917	No	No
Form	21-8919	No	No
Form	21-8915	No	No
Form	VA 21-4179	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,500,000	-100,000	1,600,000
Annual IC Time Burden (Hours)	300,000	-100,000	400,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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