Statement of Dependency of Parent(s)

Statement of Dependency of Parent(s) (21P-509)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0089 can be found here:

Documents and Forms

Document Name Document Type
Form 21P-509 Statement of Dependency of Parent(s) Form
21P-509 Statement of Dependency of Parent(s) VA Form 21P-509 (508 Conformant 9-21-17).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Statement of Dependency of Parent(s)	Agency IC Tracking Number:	21P-509

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.250 38 CFR 3.4

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21P-509	Statement of Dependency of Parent(s)	VA Form 21P-509 (508 Conformant 9-21-17).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: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	8,000	0	8,000
Annual IC Time Burden (Hours)	4,000	0	4,000
Annual IC Cost Burden (Dollars)	95,440	95,440	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.