Information Collection

Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)

IC 232032 under ICR 201807-2900-001 · OMB 2900-0862.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0862 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 20-0995 Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)	Form
20-0995 DECISION REVIEW REQUEST: SUPPLEMENTAL CLAIM VA Form 20-0995-NEW AMC (508 Compliant 9-13-18).pdf www.va.gov/vaforms	Form
20-0996 DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW VA Form 20-0996 (IAI) 10-25-18.pdf www.va.gov/vaforms	Form

IC Title:

Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)

Agency IC Tracking Number:

VBA-AMO-YA

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 2501 38 CFR 2500 38 CFR 2601

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	20-0995	DECISION REVIEW REQUEST: SUPPLEMENTAL CLAIM	VA Form 20-0995-NEW AMC (508 Compliant 9-13-18).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	20-0996	DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW	VA Form 20-0996 (IAI) 10-25-18.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: 58/VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records -VA

FR Citation: 83 FR 39818

Number of Respondents: 115,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	115,000	115,000
Annual IC Time Burden (Hours)	28,750	28,750
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.