Declaration of Status of Dependents

Declaration of Status of Dependents (21-686c)

OMB: 2900-0043

IC ID: 28162

Information Collection (IC) Details

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Declaration of Status of Dependents
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.205 38 CFR 3.209

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21-686C Declaration of Status of Dependents VA Form 21-686c (DOMA - 6-18-14).pdf http://www.va.gov/vaforms/ Yes No Fillable Printable

General Government Central Fiscal Operations

 

226,000 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 226,000 0 0 0 0 226,000
Annual IC Time Burden (Hours) 56,500 0 0 0 0 56,500
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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