Information Collection

Disability Benefits Questionnaires (Group I )

IC 195776 under ICR 201201-2900-006 · OMB 2900-0779.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0779 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0960I-6 Disability Benefits Questionnaires (Group I ) Form
VA Form 21-0960I-6 Tuberculosis Disability Benefits Questionnaire 21-0960I-6.pdf www.va.gov/vaforms Form
VA Form 21-0960M-1 Back (Thoracolumbar Spine) Conditions Disability Benefit 21-0960M-14.pdf www.va.gov/vaforms Form
VA Form 21-0960I-1 Persian Gulf and Afghanistan Infectious Diseases Disabil 21-0960I-1.pdf www.va.gov/vaforms Form
VA Form 21-0960J-3 Prostate Cancer Disability Benefits Questionnaire 21-0960J-3.pdf www.va.gov/vaforms Form
VA Form 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability 21-0960P-3.pdf www.va.gov/vaforms Form
VA Form 21-0960P-2 Mental Disorders (Other than PTSD and Eating Disorders) 21-0960P-2.pdf www.va.gov/vaforms Form
VA Form 21-0960J-2 Male Reproductive Organ Conditions Disability Benefits Q 21-0960J-2.pdf www.va.gov/vaforms Form
VA Form 21-0960C-2 Amotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disa 21-0960C-2.pdf www.va.gov/vaforms Form
VA Form 21-0960C-1 Peripheral Nerves Conditions (Not including Diabetic Sen 21-0960C-10.pdf www.va.gov/vaforms Form
VA Form 21-0960J-1 Kidney Conditions (Nephrology) Disability Benefits Quest 21-0960J-1.pdf www.va.gov/vaforms Form
VA Form 21-0960P-1 Eating Disorders Disability Benefits Questionnaire 21-0960P-1.pdf www.va.gov/vaforms Form
VA Form 21-0960B-2 Hematologic and Lymphatic Conditions, Including Leukemia 21-0960B-2.pdf www.va.gov/vaforms Form
VA Form 21-0960M-1 Neck (cervical spine) Disability Benefits Questionnaire 21-0960M-13.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disability Benefits Questionnaires (Group I )	Agency IC Tracking Number:	2900-0779

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.326 38 CFR 3.351

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0960I-6	Tuberculosis Disability Benefits Questionnaire	21-0960I-6.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-14	Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire	21-0960M-14.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960I-1	Persian Gulf and Afghanistan Infectious Diseases Disability Benefits Questionnaire	21-0960I-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960J-3	Prostate Cancer Disability Benefits Questionnaire	21-0960J-3.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960P-3	Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire	21-0960P-3.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960P-2	Mental Disorders (Other than PTSD and Eating Disorders) Disability Benefits Questionnaire	21-0960P-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960J-2	Male Reproductive Organ Conditions Disability Benefits Questionnaire	21-0960J-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960C-2	Amotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire	21-0960C-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960C-10	Peripheral Nerves Conditions (Not including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire	21-0960C-10.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960J-1	Kidney Conditions (Nephrology) Disability Benefits Questionnaire	21-0960J-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960P-1	Eating Disorders Disability Benefits Questionnaire	21-0960P-1.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960B-2	Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire	21-0960B-2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0960M-13	Neck (cervical spine) Disability Benefits Questionnaire	21-0960M-13.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: 407,000	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	407,000	407,000
Annual IC Time Burden (Hours)	213,500	213,500
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.