Information Collection

Income Verification

IC 28700 under ICR 201508-2900-014 · OMB 2900-0518.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-0161a Income Verification	Form
VA Form 21-0161a INCOME VERIFICATION VA Form 21-0161a (10-1-15) 508 Approved 10-9-15.pdf	Form

IC Title:

Income Verification

Agency IC Tracking Number:

2900-0518

Is this a Common Form? No

IC Status: Modified

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 21-0161a	INCOME VERIFICATION	VA Form 21-0161a (10-1-15) 508 Approved 10-9-15.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	15,000	15,000
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.