Information Collection

DBQs

IC 195946 under ICR 201101-2900-010 · OMB 2900-0776.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0776 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0960M-8 DBQs	Form
VA Form 21-0960A-2 Artery and Vein Conditions (Vascular Diseases Including 21-0960A-2.pdf www.va.gov/vaforms	Form
VA Form 21-0960A-3 Hypertension DBQ 21-0960A-3.pdf www.va.gov/vaforms	Form
VA Form 21-0960A-4 Non-Ischemic Heart Disease (Including Arrhythmias and Su 21-0960A-4.pdf www.va.gov/vaforms	Form
VA Form 21-0960C-4 Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor P 21-0960C-4.pdf www.va.gov/vaforms	Form
VA Form 21-0960E-1 Diabetes Mellitus DBQ 21-0960E-1.pdf www.va.gov/vaforms	Form
VA Form 21-0960F-1 Scars/Disfigurement DBQ 21-0960F-1.pdf www.va.gov/vaforms	Form
VA Form 21-0960F-2 Skin Diseases DBQ 21-0960F-2.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-1 Amputations DBQ 21-0960M-1.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-2 Ankle Conditions DBQ 21-0960M-2.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-4 Elbow and Forearm Conditions DBQ 21-0960M-4.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-5 Flatfoot (Pes Planus) DBQ 21-0960M-5.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-6 Foot Miscellaneous (Other than Flatfoot/Pes Planus) DBQ 21-0960M-6.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-7 Hand and Finger Conditions DBQ 21-0960M-7.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-8 Hip and Thigh Conditions DBQ 21-0960M-8.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-9 Knee and Lower Leg Conditions DBQ 21-0960M-9.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-1 Muscle Injuries DBQ 21-0960M-10.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-1 Shoulder and Arm Conditions DBQ 21-0960M-12.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-1 Temporomandibular Joint Conditions DBQ 21-0960M-15.pdf www.va.gov/vaforms	Form
VA Form 21-0960M-1 Wrist Conditions DBQ 21-0960M-16.pdf www.va.gov/vaforms	Form
VA Form 21-0960N-2 Eye Conditions DBQ 21-0960N-2.pdf www.va.gov/vaforms	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DBQs

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	VA Form 21-0960M-8	Hip and Thigh Conditions DBQ	21-0960M-8.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-9	Knee and Lower Leg Conditions DBQ	21-0960M-9.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-10	Muscle Injuries DBQ	21-0960M-10.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-12	Shoulder and Arm Conditions DBQ	21-0960M-12.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-15	Temporomandibular Joint Conditions DBQ	21-0960M-15.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-16	Wrist Conditions DBQ	21-0960M-16.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960N-2	Eye Conditions DBQ	21-0960N-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960A-2	Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) DBQ	21-0960A-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960A-3	Hypertension DBQ	21-0960A-3.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960A-4	Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) DBQ	21-0960A-4.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960C-4	Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) DBQ	21-0960C-4.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960E-1	Diabetes Mellitus DBQ	21-0960E-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960F-1	Scars/Disfigurement DBQ	21-0960F-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960F-2	Skin Diseases DBQ	21-0960F-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-1	Amputations DBQ	21-0960M-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-2	Ankle Conditions DBQ	21-0960M-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-4	Elbow and Forearm Conditions DBQ	21-0960M-4.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-5	Flatfoot (Pes Planus) DBQ	21-0960M-5.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-6	Foot Miscellaneous (Other than Flatfoot/Pes Planus) DBQ	21-0960M-6.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-7	Hand and Finger Conditions DBQ	21-0960M-7.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: 725,000

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	725,000	725,000
Annual IC Time Burden (Hours)	311,250	311,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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