Decision Review Request: Supplemental Claim (VA Form 20-0995)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0886 can be found here:

Documents and Forms

Document Name Document Type
Form 20-0995 Decision Review Request: Supplemental Claim (VA Form 20-0995) Form and Instruction
20-0995 Decision Review Request: Supplemental Claim VA Form 20-0995 (Non-sub changes) (YA Draft) 7-12-22.pdf www.vba.va.gov/pubs/forms/VBA-20-0995-ARE.pdf Form and Instruction
White Paper - Non-Sub Changes VA Form 0995-0996 (FINAL).pdf White Paper for OMB justifying non-sub change IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Decision Review Request: Supplemental Claim (VA Form 20-0995)	Agency IC Tracking Number:	VBA-OAR-YA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.2501

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	20-0995	Decision Review Request: Supplemental Claim	VA Form 20-0995 (Non-sub changes) (YA Draft) 7-12-22.pdf	https://www.vba.va.gov/pubs/forms/VBA-20-0995-ARE.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58/VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records	FR Citation: 84 FR 4138

Number of Respondents: 265,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	265,000	265,000
Annual IC Time Burden (Hours)	66,250	66,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
White Paper for OMB justifying non-sub change	White Paper - Non-Sub Changes VA Form 0995-0996 (FINAL).pdf	08/18/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.