Information Collection

REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)

IC 28620 under ICR 202401-2900-002 · OMB 2900-0405.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21P-8941 REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)	Form
VA Form 21P-8941 REPS Annual Eligibility Report (Under the Provisions of VA Form 21P-8941 (2-10-21).pdf www.va.gov/vaforms	Form
VA Form 21P-8941 REPS Annual Eligibility Report (Under the Provisions of VA Form 21P-8941 3-28-24.pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0405 VBA-P&F-NK

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.812

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 Form 21P-8941	REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377)	VA Form 21P-8941 3-28-24.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)

FR Citation: 84 FR 4138

Number of Respondents: 1,200

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	1,200	0	1,200
Annual IC Time Burden (Hours)	300	0	300
Annual IC Cost Burden (Dollars)	8,928	1,773	7,155

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.