Information Collection

Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check

IC 187592 under ICR 200812-2900-006 · OMB 2900-0734.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0734 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0820 Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
VA Form 21-0820 Report of General Information 21-0820.pdf www.va.gov/vaforms	Form
VA Form 21-0820a Report of Death of Veteran/Beneficiary 21-0820a.pdf www.va.gov/vaforms	Form
VA Form 21-0820b Report of Nursing Home or Assisted Living Information 21-0820b.pdf www.va.gov/vaforms	Form
VA Form 21-0820c Report of Defense Finance & Accounting Service (DFAS) 21-0820c.pdf www.va.gov/vaforms	Form
VA Form 21-0820d Report of Non-Receipt of Payment 21-0820d.pdf www.va.gov/vaforms	Form
VA Form 21-0820e Report of Incarceration 21-0820e.pdf www.va.gov/vaforms	Form
VA Form 21-0820f Report of Contact - Month of Death Claim 21-0820f.pdf www.va.gov/vaforms	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.217

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 Form 21-0820	Report of General Information	21-0820.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820a	Report of Death of Veteran/Beneficiary	21-0820a.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820b	Report of Nursing Home or Assisted Living Information	21-0820b.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820c	Report of Defense Finance & Accounting Service (DFAS)	21-0820c.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820d	Report of Non-Receipt of Payment	21-0820d.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820e	Report of Incarceration	21-0820e.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820f	Report of Contact - Month of Death Claim	21-0820f.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:

FR Citation:

Number of Respondents: 2,550,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	2,550,000	2,550,000
Annual IC Time Burden (Hours)	35,501	35,501
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.