Information Collection

Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check

IC 187592 under ICR 201203-2900-019 · OMB 2900-0734.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0734 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0820 Report of General Information Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820a Report of Death of Veteran/Beneficiary Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820b Report of Nursing Home or Assisted Living Information Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820c Report of Defense Finance & Accounting Service (DFAS) Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820d Report of Non-Receipt of Payment Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820e Report of Incarceration Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
Form VA Form 21-0820f Report of Contact - Month of Death Claim Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	Form
VA Form 21-0820 Report of General Information 21-0820.pdf	Form
VA Form 21-0820a Report of Death of Veteran/Beneficiary 21-0820a.pdf	Form
VA Form 21-0820b Report of Nursing Home or Assisted Living Information 21-0820b.pdf	Form
VA Form 21-0820c Report of Defense Finance & Accounting Service (DFAS) 21-0820c.pdf	Form
VA Form 21-0820d Report of Non-Receipt of Payment 21-0820d.pdf	Form
VA Form 21-0820e Report of Incarceration 21-0820e.pdf	Form
VA Form 21-0820f Report of Contact - Month of Death Claim 21-0820f.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check

Agency IC Tracking Number:

2900-0734

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.217

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0820	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820a	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820b	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820c	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820d	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820e	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820f	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: 2,550,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,550,000	0	2,550,000
Annual IC Time Burden (Hours)	212,500	176,999	35,501
Annual IC Cost Burden (Dollars)	0	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.

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