Information Collection

Notice of Disagreement (VA Form 21-0958)

IC 202598 under ICR 201803-2900-001 · OMB 2900-0791.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-0958 Notice of Disagreement Notice of Disagreement (VA Form 21-0958)	Form
21-0958 Notice of Disagreement VA Form 21-0958 (OMB Expiring - 1-3-18)_FINAL.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 4.16 38 CFR 3.326 38 CFR 3.351

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	21-0958			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: 199,800

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	199,800	55,800	144,000
Annual IC Time Burden (Hours)	49,950	-22,050	72,000
Annual IC Cost Burden (Dollars)	0	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.

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