Information Collection

Statement of Disappearance

IC 28145 under ICR 202502-2900-007 · OMB 2900-0036.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 22-1775 Statement of Disappearance	Form
Form VA Form 22-1775 Statement of Disappearance Statement of Disappearance	Form
VA Form 22-1775 Statement of Disappearance 21P-1775(5-22-2025).pdf www.va.gov/vaforms	Form
VA Form 22-1775 Statement of Disappearance 21P-1775(5-22-2025).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0036

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	VA Form 22-1775			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: 10

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	10	10
Annual IC Time Burden (Hours)	28	28
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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