Information Collection

Statement in Support of Claim (VA Form 21-4138)

IC 28224 under ICR 201709-2900-013 · OMB 2900-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-4138 Statement in Support of Claim (VA Form 21-4138)	Form
21-4138 Statement in Support of Claim VA Form 21-4138 (508 Compliant 5-16-17).pdf www.va.gov/vaforms	Form

IC Title:

Statement in Support of Claim (VA Form 21-4138)

Agency IC Tracking Number:

VBA-COMP-YA

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.150

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	21-4138	Statement in Support of Claim	VA Form 21-4138 (508 Compliant 5-16-17).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: 752,000

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	752,000	752,000
Annual IC Time Burden (Hours)	188,000	188,000
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.