Information Collection

Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4)

IC 206556 under ICR 201612-2900-012 · OMB 2900-0812.

Documents and Forms

Document Name Document Type
Form 21-0960M-4 Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4) Form
21-0960M-4 Elbow and Forearm Conditions Disability Benefits Questio 21-0960M-4(12-19-16).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Elbow and Forearm Conditions Disability Benefits Questionnaire (21-0960M-4)	Agency IC Tracking Number:	2900-0812

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.326 38 CFR 3.351

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0960M-4	Elbow and Forearm Conditions Disability Benefits Questionnaire	21-0960M-4(12-19-16).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.