Information Collection

Notice of Disagreement (21-0958)

IC 202598 under ICR 201401-2900-003 · OMB 2900-0791.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0791 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0958 Notice of Disagreement (21-0958)	Form
VA Form 21-0958 Notice of Disagreement 21-0958(8-14).pdf www.va.gov/vaforms	Form

IC Title:

Notice of Disagreement (21-0958)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.351 38 CFR 4.16 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	VA Form 21-0958	Notice of Disagreement	21-0958(8-14).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: 144,000

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	Previously Approved
Annual Number of Responses for this IC	144,000	144,000
Annual IC Time Burden (Hours)	72,000	72,000
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.