Information Collection

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)

IC 28320 under ICR 202207-2900-001 · OMB 2900-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0116 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA 21-4193 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)	Form
VA 21-4193 Notice to Department of Veterans Affairs of Veteran or B VBA-21-4193-(07-08-2022).pdf www.va.gov/vaforms	Form
VA 21-4193 Notice to Department of Veterans Affairs of Veteran or B VBA-21-4193-(07-08-2022).pdf www.va.gov/vaforms	Form

IC Title:

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	VA 21-4193	Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution	VBA-21-4193-(07-08-2022).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: 7,997

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	7,997	6,333	1,664
Annual IC Time Burden (Hours)	1,999	1,583	416
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.