Information Collection

Alternate Signer Certification

IC 220635 under ICR 202210-2900-006 · OMB 2900-0849.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0849 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0972 Alternate Signer Certification Form
VA Form 21-0972 Alternate Signer Certification 21-0972(10-19-22).pdf www.va.gov/vaforms Form
VA Form 21-0972 Alternate Signer Certification 21-0972(10-19-22).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Alternate Signer Certification	Agency IC Tracking Number:	2900-0849

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0972	Alternate Signer Certification	21-0972(10-19-22).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education, and Veterans Readiness and Employment Records	FR Citation: 87 FR 8740

Number of Respondents: 18,575	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	18,575	13,575	5,000
Annual IC Time Burden (Hours)	4,644	3,394	1,250
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.