Information Collection

Certificate as to Assets

IC 28292 under ICR 201404-2900-009 · OMB 2900-0107.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-4709 Certificate As To Assets Certificate as to Assets	Form
VA Form 21-4709 Certificate As To Assets 21P-4709.pdf	Form

IC Title:

Agency IC Tracking Number:

2900-0107

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 13.100 38 CFR 13.104

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 21-4709			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: 4,316

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	4,316	4,316
Annual IC Time Burden (Hours)	863	863
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.

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