Information Collection

Declaration of Status of Dependents

IC 28162 under ICR 201009-2900-019 · OMB 2900-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0043 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-686C Declaration of Status of Dependents	Form
21-686C Declaration of Status of Dependents VA Form 21-686c.pdf www.va.gov/vaforms/	Form

IC Title:

Declaration of Status of Dependents

Agency IC Tracking Number:

2900-0043

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.205 38 CFR 3.209

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	21-686C	Declaration of Status of Dependents	VA Form 21-686c.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 226,000

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	Previously Approved
Annual Number of Responses for this IC	226,000	226,000
Annual IC Time Burden (Hours)	56,500	56,500
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.