Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

ICR 202306-2900-023

OMB: 2900-0829

Federal Form Document

Forms and Documents
ICR Details
2900-0829 202306-2900-023
Historical Inactive 202108-2900-017
Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)
Revision of a currently approved collection   No
Improperly submitted and continue 09/15/2023
Retrieve Notice of Action (NOA) 09/15/2023
  Inventory as of this Action Requested Previously Approved
12/31/2024 36 Months From Approved 12/31/2024
75,000 0 75,000
31,250 0 31,250
0 0 0

VA Form 21P-0969 will be used by claimants for VA Pension or Parents' Dependency and Indemnity Compensation (DIC) to provide information pertaining to income and assets to establish entitlement to Pension or Parents' DIC. This form will be completed only by those claimants who had income other than Social Security benefits during the calendar year before claiming benefits or who disposed of assets or have significant assets which may affect their entitlement to needs-based benefits.

US Code: 38 USC 1503 Name of Law: Determinations with respect to annual income
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 1543 Name of Law: Net worth limitation

Not associated with rulemaking

  88 FR 43171 07/06/2023
88 FR 63677 09/15/2023

Miscellaneous Actions
Burden time decreased due to reduction in actual and estimated receipts.

Maribel Aponte 202 266-4688 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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