Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (21-0960M-14)

Back (Thoracolumbar Spine)Conditions Disability Benefits Questionnaire (21-0960M-14)

OMB: 2900-0808

IC ID: 206616

Information Collection (IC) Details

View Information Collection (IC)

Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (21-0960M-14) 2900-NEW VBA-COMP-DB
 
Yes Modified
 
Voluntary
 
38 CFR 3.351(d) 38 CFR 3.351(e) 38 CFR 3.326

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960M-14 Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire VA Form 21-0960M-14 (508 Conformant 1-19-17).pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  74 FR 29275

50,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50,000 0 0 0 0 50,000
Annual IC Time Burden (Hours) 37,500 0 0 0 0 37,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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