Information Collection

Pension Claim Questionnaire for Farm Income

IC 28263 under ICR 202502-2900-011 · OMB 2900-0095.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21P-4165 Pension Claim Questionnaire for Farm Income	Form and Instruction
Form 21P-4165 Pension Claim Questionnaire for Farm Income Pension Claim Questionnaire for Farm Income	Form and Instruction
21P-4165 Pension Claim Questionnaire for Farm Income VBA-21P-4165-ARE 8-22-25.pdf www.va.gov/vaforms	Form and Instruction
21P-4165 Pension Claim Questionnaire for Farm Income VBA-21P-4165-ARE 8-22-25.pdf www.va.gov/vaforms	Form and Instruction

IC Title:

Agency IC Tracking Number:

2900-0095

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.262 38 CFR 3.271 38 CFR 3.272 38 CFR 3.275

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	21P-4165			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: 218

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	218	218
Annual IC Time Burden (Hours)	109	109
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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