Information Collection

Intent To File A Claim For Compensation And/or Pension, Survivors Pension, Or Other Benefits

IC 212535 under ICR 201407-2900-019 · OMB 2900-0826.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0826 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0966 INTENT TO FILE A CLAIM FOR COMPENSATION AND/OR PENSION, SURVIVORS PENSION, OR OTHER BENEFITS	Form
VA Form 21-0966 Intent to File a Claim for Compensation or Pension, Surv 21-0966(11-14).pdf www.va.gov/vaforms	Form

IC Title:

INTENT TO FILE A CLAIM FOR COMPENSATION AND/OR PENSION, SURVIVORS PENSION, OR OTHER BENEFITS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 21-0966	Intent to File a Claim for Compensation or Pension, Survivors Pension, or Other Benefits	21-0966(11-14).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: 724,561

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	724,561	724,561
Annual IC Time Burden (Hours)	181,140	181,140
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.