Income-Net Worth and Employment Statement

Income-Net Worth and Employment Statement (VA Form 21P-527) and Application for Pension (VA Form 21P-527EZ)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0002 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21P-527 Income-Net Worth and Employment Statement Form
VA Form 21P-527 INCOME, ASSET, AND EMPLOYMENT STATEMENT 21P-527(7-30-14).pdf www.va.gov/vaforms Form
VA Form 21P-527EZ APPLICATION FOR VETERANS PENSION 21P-527EZ(9-14).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Income-Net Worth and Employment Statement	Agency IC Tracking Number:	2900-0002

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.340 38 CFR 3.342

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21P-527	INCOME, ASSET, AND EMPLOYMENT STATEMENT	21P-527(7-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21P-527EZ	APPLICATION FOR VETERANS PENSION	21P-527EZ(9-14).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: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100,000	-18,197	118,197
Annual IC Time Burden (Hours)	56,500	-2,730	59,230
Annual IC Cost Burden (Dollars)	1,350,000	1,350,000	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.