Information Collection

Residency Verification Report-Veterans and Survivors (FL21-914)

IC 28931 under ICR 202309-2900-008 · OMB 2900-0655.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA FL 21-914 Residency Verification Report-Veterans and Survivors (FL21-914)	Form
VA FL 21-914 Residency Verification Report - Veterans and Survivors FL 21-914(9-26-23).pdf www.va.gov/vaforms	Form
VA FL 21-914 Residency Verification Report - Veterans and Survivors FL 21-914(9-26-23).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.42

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 FL 21-914	Residency Verification Report - Veterans and Survivors	FL 21-914(9-26-23).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 Veteran Readiness and Employment Records - VA

FR Citation: 88 FR 26548

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	900	-350	1,250
Annual IC Time Burden (Hours)	75	-342	417
Annual IC Cost Burden (Dollars)	0	-613	613

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.