Information Collection

Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

IC 214403 under ICR 202108-2900-017 · OMB 2900-0829.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0829 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21P-0969 Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)	Form
21P-0969 Income and Asset Statement in Support of Claim for Pensi VA Form 21P-0969 (OMB Exp. 10-31-21) 8-18-21.pdf www.va.gov/vaforms	Form
21P-0969 Income and Asset Statement in Support of Claim for Pensi VA Form 21P-0969 (OMB Exp. 10-31-21) 8-18-21.pdf www.va.gov/vaforms	Form

IC Title:

Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

Agency IC Tracking Number:

2900-0829

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.5 38 CFR 3.275

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	21P-0969	Income and Asset Statement in Support of Claim for Pension or Parents' DIC	VA Form 21P-0969 (OMB Exp. 10-31-21) 8-18-21.pdf	www.va.gov/vaforms	Yes	No	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)

FR Citation: 84 FR 4138

Number of Respondents: 75,000

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	75,000	15,000	60,000
Annual IC Time Burden (Hours)	31,250	6,250	25,000
Annual IC Cost Burden (Dollars)	0	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.