Information Collection

Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet

IC 184617 under ICR 201704-2900-003 · OMB 2900-0720.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-0773 Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet	Form
21-0773 Global War on Terrorism Seriously Injured/ILL Servicemem VA Form 21-0773 - 508 Conformant (4-10-17).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0720

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	21-0773	Global War on Terrorism Seriously Injured/ILL Servicemember/Veteran Worksheet	VA Form 21-0773 - 508 Conformant (4-10-17).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: 14,000

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	14,000	14,000
Annual IC Time Burden (Hours)	7,000	7,000
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.