Information Collection

Application Request to Add and/or Remove Dependents (VA Form 21-686c)

IC 28162 under ICR 202111-2900-008 · OMB 2900-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0043 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-686c Application Request to Add and/or Remove Dependents (VA Form 21-686c) Form
VA Form 21-686c Application Request to Add and/or Remove Dependents 21-686c(5-19-22).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Request to Add and/or Remove Dependents (VA Form 21-686c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.209 38 CFR 3.205

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-686c	Application Request to Add and/or Remove Dependents	21-686c(5-19-22).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: 58VA 21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment Records - VA	FR Citation: 87 FR 8740

Number of Respondents: 369,162	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 66 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	369,162	143,162	226,000
Annual IC Time Burden (Hours)	184,581	71,581	113,000
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.