Information Collection

Request for Contact Information (FL21-30)

IC 28938 under ICR 201701-2900-003 · OMB 2900-0660.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0660 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FL 21-30 Request for Contact Information (FL21-30)	Form
FL 21-30 Request for Contact Information VA Form Letter 21-30 (1-3-17) 508 Compliant 2-9-17.pdf www.va.gov/vaforms	Form

IC Title:

Request for Contact Information (FL21-30)

Agency IC Tracking Number:

2900-0660 VBA-COMP-DB

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	FL 21-30	Request for Contact Information	VA Form Letter 21-30 (1-3-17) 508 Compliant 2-9-17.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: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
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.