Information Collection

35% exemption Request From 85-15 Reporting Requirement

IC 248396 under ICR 202107-2900-004 · OMB 2900-0896.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0896 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 22-10216 35% exemption Request From 85-15 Reporting Requirement	Form
VA Form 22-10216 35% Exemption Request From 85-15 Reporting Requirement 22-10216(2-23-21).pdf www.va.gov/vaforms	Form
VA Form 22-10216 35% Exemption Request From 85-15 Reporting Requirement 22-10216(2-23-21).pdf www.va.gov/vaforms	Form

IC Title:

35% exemption Request From 85-15 Reporting Requirement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 22-10216	35% Exemption Request From 85-15 Reporting Requirement	22-10216(2-23-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: 58VA21/22/28, Compensation, Pension, Education, Veteran Readiness and Employment Records - VA

FR Citation: 84 FR 4138

Number of Respondents: 1,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	500	500
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.