Information Collection

Residency Verification Report-Veterans and Survivors

IC 28931 under ICR 201610-2900-004 · OMB 2900-0655.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0655 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FL21-914 Residency Verification Report (RVR) - Veterans and Survivors Residency Verification Report-Veterans and Survivors	Form
FL21-914 Residency Verification Report (RVR) - Veterans and Survi FL 21-914.pdf	Form

IC Title:

Residency Verification Report-Veterans and Survivors

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.42

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	FL21-914				No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,250

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	1,250	1,250
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	613	613

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.

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