Information Collection

Election to Waive, Retain, or Re-Elect Due Process Rights if in Receipt of Concurrent Active Duty Service Pay and Disability Compensation Pay (VA Form 21-10213)

IC 249004 under ICR 202108-2900-019 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VAF 21-10213 Election to Waive, Retain, or Re-Elect Due Process Rights if in Receipt of Concurrent Active Duty Service Pay and Disability Compensation Pay (VA Form 21-10213)	Form
VAF 21-10213 Election to Waive, Retain, or Re-Elect Due Process Right VAF 21-10213, Final Draft (8-20-2021).pdf www.va.gov/vaforms	Form
VAF 21-10213 Election to Waive, Retain, or Re-Elect Due Process Right VAF 21-10213, Final Draft (8-20-2021).pdf www.va.gov/vaforms	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Election to Waive, Retain, or Re-Elect Due Process Rights if in Receipt of Concurrent Active Duty Service Pay and Disability Compensation Pay (VA Form 21-10213)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.103 38 CFR 3.654

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	VAF 21-10213	Election to Waive, Retain, or Re-Elect Due Process Rights if in Receipt of Concurrent Active Duty Service Pay and Disability Compensation Pay	VAF 21-10213, Final Draft (8-20-2021).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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 24420

Number of Respondents: 100,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	8,333	8,333
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.