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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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:

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 21-0960I-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 %

table that charts list of burden
	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

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.