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Federal forms, ICRs, and supporting documents

Information Collection

Disability Benefits Questionnaires (Group 4)

IC 196008 under ICR 201903-2900-012 · OMB 2900-0781.

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Information Collection (IC) Details

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Disability Benefits Questionnaires (Group 4) 2900-0781
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960C-3 Cranial Nerves Diseases Disability Benefits Questionnaire VBA-21-0960C-3-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-6 Narcolepsy Disability Benefits Questionnaire VBA-21-0960C-6-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-7 Fibromyalgia Disability Benefits Questionnaire VBA-21-0960C-7-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-11 Seizure Disorders (Epilepsy) Disability Benefits Questionnaire VBA-21-0960C-11-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960H-1 Hernias (Including Abdominal, Inguinal and Femoral Hernias) Disability Benefits Questionnaire VBA-21-0960H-1-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-2 HIV-Related Illnesses Disability Benefits Questionnaire VBA-21-0960I-2-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-3 Infectious Diseases (Other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis) Disability Benefits Questionnaire VBA-21-0960I-3-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-4 Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases Disability Benefits Questionnaire VBA-21-0960I-4-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-5 Nutritional Deficiencies Disability Benefits Questionnaire VBA-21-0960I-5-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960D-1 Oral and Dental Conditions Including Mouth, Lips and Tongue (Other than Temporomandibular Joint Conditions) Disability Benefits Questionnaire VBA-21-0960D-1-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960E-2 Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus) Disability Benefits Questionnaire VBA-21-0960E-2-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960E-3 Thyroid and Parathyroid Conditions VBA-21-0960E-3-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960J-4 Urinary Tract (Including Bladder and Urethra Conditions) (Excluding Male Reproductive System Disability Benefits Questionnaire VBA-21-0960J-4-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960L-1 Respiratory Conditions (Other than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire VBA-21-0960L-1-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-3 Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire VBA-21-0960N-3-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-4 Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx Disability Benefits Questionnaire VBA-21-0960N-4-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960Q-1 Chronic Fatigue Syndrome Disability Benefits Questionnaire VBA-21-0960Q-1-ARE.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

 

160,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 160,000 0 0 0 0 160,000
Annual IC Time Burden (Hours) 53,750 0 0 0 0 53,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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