Information Collection

Certification of Fully Developed Claim

IC 191044 under ICR 200903-2900-005 · OMB 2900-0747.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0747 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-0844 Certification of Fully Developed Claim	Form
21-0844 Certification of Fully Developed Claim 21-0844.pdf www.va.gov/vaforms	Form

IC Title:

Certification of Fully Developed Claim

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	21-0844	Certification of Fully Developed Claim	21-0844.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,584

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,584	1,584
Annual IC Time Burden (Hours)	132	132
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.