Information Collection

Wrist Conditions Disability Benefits Questionnaire (21-0960M-16)

IC 206617 under ICR 201711-2900-009 · OMB 2900-0805.

Documents and Forms

Document Name Document Type
Form VA Form 21-0960M-1 Wrist Conditions Disability Benefits Questionnaire (21-0960M-16) Form
VA Form 21-0960M-1 Wrist Conditions Disability Benefits Questionnaire VA Form 21-0960M-16.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Wrist Conditions Disability Benefits Questionnaire (21-0960M-16)	Agency IC Tracking Number:	2900-NEW VBA-COMP-DB

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.351(d) and (e) 38 CFR 3.326

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0960M-16	Wrist Conditions Disability Benefits Questionnaire	VA Form 21-0960M-16.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 74 FR 29275

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	20,000	20,000
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.