Information Collection

Request for Contact Information (FL21P-30)

IC 28938 under ICR 202009-2900-009 · OMB 2900-0660.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form FL21-30 Request for Contact Information (FL21P-30)	Form
VA Form FL21-30 Request for Contact Information FL21-30(2-22-21).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0660

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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 FL21-30	Request for Contact Information	FL21-30(2-22-21).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, Vocational Rehabilitation and Employment Records -VA

FR Citation: 86 FR 7527

Number of Respondents: 5,000

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
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.