Information Collection

VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a)

IC 28106 under ICR 202108-2900-003 · OMB 2900-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0017 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21P-4706b VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a) Form
VA Form 21P-4706b VA Fiduciary's Account 21P-4706b(8-4-21).pdf www.va.gov/vaforms Form
VA Form 21P-4706b VA Fiduciary's Account 21P-4706b(8-4-21).pdf www.va.gov/vaforms Form
VA Form 21P-4706c Court Appointed Fiduciary's Account 21P-4706c(8-4-21).pdf www.va.gov/vaforms Form
VA Form 21P-4706c Court Appointed Fiduciary's Account 21P-4706c(8-4-21).pdf www.va.gov/vaforms Form
VA Form 21P-4718a Certificate of Balance on Deposit and Authorization to D 21P-4718a(8-4-21).pdf www.va.gov/vaforms Form
VA Form 21P-4718a Certificate of Balance on Deposit and Authorization to D 21P-4718a(8-4-21).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a)	Agency IC Tracking Number:	2900-0017

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 13.280 38 CFR 13.200 38 CFR 13.210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21P-4706b	VA Fiduciary's Account	21P-4706b(8-4-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21P-4706c	Court Appointed Fiduciary's Account	21P-4706c(8-4-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21P-4718a	Certificate of Balance on Deposit and Authorization to Disclose Financial Records	21P-4718a(8-4-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA 21/22/28 Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),	FR Citation: 86 FR 23492

Number of Respondents: 53,159	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	53,159	19,659	33,500
Annual IC Time Burden (Hours)	17,720	6,553	11,167
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.