Information Collection

Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)

IC 28062 under ICR 201312-2900-025 · OMB 2900-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-4142 Authorization to Disclose Information to the Department of Veterans Affairs (VA) Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)	Form
Form VA Form 21-526 Veterans Application for Compensation and/or Pension Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)	Form
Form VA Form 21-526b Supplemental Application for Compensation Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)	Form
Form VA Form 21-4142a General Release for Medical Provider Information To the Department of Veterans Affairs (VA) Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)	Form
VA Form 21-4142 Authorization to Disclose Information to the Department 21-4142(draft3).pdf	Form
VA Form 21-526 Veterans Application for Compensation and/or Pension VBA-21-526-ARE.pdf	Form
VA Form 21-526b Supplemental Application for Compensation VBA-21-526b-ARE.pdf	Form
VA Form 21-4142a General Release for Medical Provider Information To the 21-4142a(2-14).pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Veteran's Application for Compensation and/ or Pension(21-526), Supplemental Application for Compensation(21-526b), Authorization to Disclose Information to the Department of Veterans Affairs(21-4142)

Agency IC Tracking Number:

2900-0001 VBA-COMP-NK

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 21-4142	www.va.gov/vaforms	Yes	Yes	Fillable Printable
Form	VA Form 21-526	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-526b	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-4142a	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: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)

FR Citation: 75 FR 22187

Number of Respondents: 724,108

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	724,108	129,108	595,000
Annual IC Time Burden (Hours)	452,740	10,758	441,982
Annual IC Cost Burden (Dollars)	10,865,760	10,865,760	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].