Information Collection

Application for Benefits for a Qualifying Veteran's Child Born with Disabilities

IC 28777 under ICR 201903-2900-011 · OMB 2900-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0572 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0304 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities Form
VA Form 21-0304 Application for Benefits for a Qualifying Veteran's Chil 21-0304(11-27-19).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities	Agency IC Tracking Number:	2900-0572

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0304	Application for Benefits for a Qualifying Veteran's Child Born with Disabilites	21-0304(11-27-19).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records	FR Citation: 84 FR 11583

Number of Respondents: 430	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	430	430
Annual IC Time Burden (Hours)	72	72
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.