Information Collection

Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans

IC 28777 under ICR 200909-2900-008 · OMB 2900-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0572 can be found here:

Documents and Forms

Document Name Document Type
Form 21-0304 Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans Form
21-0304 Application for Benefits for Certain Children with Disab 2900-0572 VA Form 21-0304.pdf www.vba.va.gov/pubs/forms/21-0304.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans	Agency IC Tracking Number:	2900-0572

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0304	Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veteran	2900-0572 VA Form 21-0304.pdf	www.vba.va.gov/pubs/forms/21-0304.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 430	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	430	430
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.