Declaration of Status of Dependents

Declaration of Status of Dependents (21-686c)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0043 can be found here:

Documents and Forms

Document Name Document Type
Form 21-686C Declaration of Status of Dependents Form
21-686C Declaration of Status of Dependents VA Form 21-686c (DOMA - 6-18-14).pdf www.va.gov/vaforms/ Form

Information Collection (IC) Details

IC Title:	Declaration of Status of Dependents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.205 38 CFR 3.209

Information Collection Instruments:

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

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 226,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	226,000	226,000
Annual IC Time Burden (Hours)	56,500	56,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.