Information Collection

Application for Accreditation as Service Organization Representative

IC 28110 under ICR 201508-2900-002 · OMB 2900-0018.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0018 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA21 Application for Accreditation as Service Organization Representative	Form
VA21 Application for Accreditation As Service Organization Re Form VA21.pdf vaww.va.gov/vaforms/va/pdf/VA21.pdf	Form

IC Title:

Application for Accreditation as Service Organization Representative

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 14.633(b) 38 CFR 14.629(a) 38 CFR 14.626

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	VA21	Application for Accreditation As Service Organization Representative	Form VA21.pdf	http://vaww.va.gov/vaforms/va/pdf/VA21.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,157

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,157	-1,623	4,780
Annual IC Time Burden (Hours)	782	-221	1,003
Annual IC Cost Burden (Dollars)	0	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.