Information Collection

Fiduciary Agreement

IC 28528 under ICR 201607-2900-006 · OMB 2900-0319.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0319 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21P-4703 Fiduciary Agreement	Form
21P-4703 FIDUCIARY AGREEMENT VA Form 21P-4703-NEW REGS VERSION (9-16-15) 2.pdf www.va.gov/vaforms	Form

IC Title:

Fiduciary Agreement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 38 CFR 13.57 38 CFR 13.62 38 CFR 13.63 38 CFR 13.61 38 CFR 13.58

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	21P-4703	FIDUCIARY AGREEMENT	VA Form 21P-4703-NEW REGS VERSION (9-16-15) 2.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: 58VA21/22/28 "Compensation, Pension, Education and Rehabilitation Records- VA"

FR Citation: 74 FR 117

Number of Respondents: 47,000

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	Previously Approved
Annual Number of Responses for this IC	47,000	47,000
Annual IC Time Burden (Hours)	3,917	3,917
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.