Information Collection

Application For Dependency And Indemnity Compensation Or Death Pension (including Accrued Benefits Where Applicable) From The Department Of Veterans Affairs

IC 147789 under ICR 199211-2900-002 · OMB 2900-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0255 can be found here:

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Information Collection (IC) Details

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IC Title:

APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION (INCLUDING ACCRUED BENEFITS WHERE APPLICABLE) FROM THE DEPARTMENT OF VETERANS AFFAIRS

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA-21-4182				No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	3,500	3,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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