Information Collection

Lay/Witness Statement (VA Form 21-10210)

IC 242781 under ICR 202009-2900-002 · OMB 2900-0881.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0881 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21-10210 Lay/Witness Statement (VA Form 21-10210)	Form
VA Form 21-10210 Lay/Witness Statement VAF 21-10210 (03-04-2021).pdf www.va.gov/vaforms	Form
VA Form 21-10210 Lay/Witness Statement VAF 21-10210 (03-04-2021).pdf www.va.gov/vaforms	Form

IC Title:

Lay/Witness Statement (VA Form 21-10210)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.159 38 CFR 3.303

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	VA Form 21-10210	Lay/Witness Statement	VAF 21-10210 (03-04-2021).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, Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)

FR Citation: 84 FR 4138

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	16,667	16,667
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.