Information Collection

Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)

IC 28777 under ICR 202211-2900-007 · OMB 2900-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0572 can be found here:

Documents and Forms

Document Name Document Type
Form 21-0304 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304) Form
21-0304 Application for Benefits for a Qualifying Veteran's Chil VA Form 21-0304 (2-2-23).pdf www.va.gov/vaforms Form
21-0304 Application for Benefits for a Qualifying Veteran's Chil VA Form 21-0304 (2-2-23).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)	Agency IC Tracking Number:	2900-0572

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0304	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities	VA Form 21-0304 (2-2-23).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: 688	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	688	258	430
Annual IC Time Burden (Hours)	115	43	72
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.