Pension Claim Questionnaire for Farm Income

Pension Claim Questionnaire for Farm Income (VA Form 21P-4165)

Documents and Forms

Document Name Document Type
Form 21P-4165 Pension Claim Questionnaire for Farm Income Form
21P-4165 Pension Claim Questionnaire for Farm Income VBA-21P-4165 (04282022).pdf www.va.gov/vaforms Form
21P-4165 Pension Claim Questionnaire for Farm Income VBA-21P-4165 (04282022).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Pension Claim Questionnaire for Farm Income	Agency IC Tracking Number:	2900-0095

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.271 38 CFR 3.272 38 CFR 3.275 38 CFR 3.262

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21P-4165	Pension Claim Questionnaire for Farm Income	VBA-21P-4165 (04282022).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 Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 84 FR 4138

Number of Respondents: 218	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	218	-1,857	2,075
Annual IC Time Burden (Hours)	109	-929	1,038
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.