Information Collection

IRS-SSA Veteran Reported Income

IC 249237 under ICR 202501-2900-009 · OMB 2900-0867.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-301 IRS-SSA Veteran Reported Income	Form and Instruction
Form 10-301 IRS-SSA Veteran Reported Income IRS-SSA Veteran Reported Income	Form and Instruction
10-301 IRS-SSA Veteran Reported Income VA Form 10-301_revised draft_2025.pdf	Form and Instruction
10-301 IRS-SSA Veteran Reported Income VA Form 10-301_revised draft_2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

2900-0867

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 and Instruction	10-301				Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55,896

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	Previously Approved
Annual Number of Responses for this IC	55,896	55,896
Annual IC Time Burden (Hours)	27,948	27,948
Annual IC Cost Burden (Dollars)	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.

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