Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

OMB: 2900-0067

IC ID: 28212

Information Collection (IC) Details

View Information Collection (IC)

Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.808

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21-4502 Application for Automobile or Other Conveyance and Adaptive Equipment VBA-21-4502-ARE(03-11-2021).pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  84 FR 4138

1,645 0
   
Individuals or Households
 
   0 %

  Requested 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 1,645 0 93 0 1,552 0
Annual IC Time Burden (Hours) 411 0 23 0 388 0
Annual IC Cost Burden (Dollars) 0 0 -9,312 0 9,312 0

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