Information Collection

Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)

IC 28260 under ICR 202404-2900-004 · OMB 2900-0094.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)	Form
21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 VBA-21-4169-ARE 4-25-24.pdf www.va.gov/vaforms	Form
21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 VBA-21-4169-ARE 7-22-24.pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0094

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.40

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	21-4169	Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169)	VBA-21-4169-ARE 7-22-24.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 Veteran Readiness and Employment Records-VA (58VA21/22/28)

FR Citation: 87 FR 8740

Number of Respondents: 849

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	849	-151	1,000
Annual IC Time Burden (Hours)	212	-38	250
Annual IC Cost Burden (Dollars)	0	0	0

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.