Information Collection

Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4)

IC 206556 under ICR 201304-2900-011 · OMB 2900-0812.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0812 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-0960M-4 Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4)	Form and Instruction
21-0960M-4 Elbow Conditions Disability Benefits Questionnaire 21-0960M-4.pdf www.va.gov/vaforms/	Form and Instruction

IC Title:

Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4)

Agency IC Tracking Number:

2900-NEW VBA-COMP-DB

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.351 38 CFR 3.326

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 and Instruction	21-0960M-4	Elbow Conditions Disability Benefits Questionnaire	21-0960M-4.pdf	http://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: 20,000

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	20,000	20,000
Annual IC Time Burden (Hours)	10,000	10,000
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.