Disability Benefits Questionnaires (Group 2)

Disability Benefits Questionnaires (Group 2)

OMB: 2900-0776

IC ID: 195946

Information Collection (IC) Details

View Information Collection (IC)

Disability Benefits Questionnaires (Group 2) 2900-0776 VBA-COMP-DB
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960A-2 Artery and Vein Conditions (Vascular Diseases including Varicose Veins) Disability Benefits Questionnaire 21-0960A-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960F-1 Scars/Disfigurement Disability Benefits Questionnaire 21-0960F-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-15 Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire 21-0960M-15.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-4 Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire 21-0960A-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire 21-0960C-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-2 Eye Conditions Disability Benefits Questionnaire 21-0960N-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-3 Hypertension Disability Benefits Questionnaire 21-0960A-3.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-1 Amputations Disability Benefits Questionnaire 21-0960M-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960F-2 Skin Diseases Disability Benefits Questionnaire 21-0960F-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-10 Muscle Injuries Disability Benefits Questionnaire 21-0960M-10.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960E-1 Diabetes Mellitus Disability Benefits Questionnaire 21-0960E-1.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  75 FR 22187

400,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400,000 0 -325,000 0 0 725,000
Annual IC Time Burden (Hours) 162,500 0 -148,750 0 0 311,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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