Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)

Documents and Forms

Document Name Document Type
Form VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680) Form
VA Form 21-2680 Examination for Housebound Status or Permanent Need for 21-2680(1-18-23).pdf www.va.gov/vaforms Form
VA Form 21-2680 Examination for Housebound Status or Permanent Need for 21-2680(1-18-23).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)	Agency IC Tracking Number:	2900-0721

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.351(d) 38 CFR 3.351(d)(2) 38 CFR 3.351 38 CFR 3.351(c)(2) 38 CFR 4.16 38 CFR 3.326(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-2680	Examination for Housebound Status or Permanent Need for Regular Aid and Attendance	21-2680(1-18-23).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Veteran Readiness and Employment Records-VA (58VA21/22/28)	FR Citation: 87 FR 8740

Number of Respondents: 103,915	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	103,915	89,915	14,000
Annual IC Time Burden (Hours)	51,958	44,958	7,000
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.