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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form VA Form 21-0820 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 www.va.gov/vaforms Form
VA Form 21-0820a Report of Death of Veteran/Beneficiary 21-0820a.pdf www.va.gov/vaforms Form
VA Form 21-0820b Report of Nursing Home or Assisted Living Information 21-0820b.pdf www.va.gov/vaforms Form
VA Form 21-0820c Report of Defense Finance & Accounting Service (DFAS) 21-0820c.pdf www.va.gov/vaforms Form
VA Form 21-0820d Report of Non-Receipt of Payment 21-0820d.pdf www.va.gov/vaforms Form
VA Form 21-0820e Report of Incarceration 21-0820e.pdf www.va.gov/vaforms Form
VA Form 21-0820f Report of Contact - Month of Death Claim 21-0820f.pdf www.va.gov/vaforms 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0820	Report of General Information	21-0820.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820a	Report of Death of Veteran/Beneficiary	21-0820a.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820b	Report of Nursing Home or Assisted Living Information	21-0820b.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820c	Report of Defense Finance & Accounting Service (DFAS)	21-0820c.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820d	Report of Non-Receipt of Payment	21-0820d.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820e	Report of Incarceration	21-0820e.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0820f	Report of Contact - Month of Death Claim	21-0820f.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

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 %

	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

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.