Information Collection

Pension Claim Questionnaire for Farm Income

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

Documents and Forms

Document Name Document Type
Form 21P-4165 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pension Claim Questionnaire for Farm Income	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	21P-4165	Pension Claim Questionnaire for Farm Income	VBA-21P-4165-ARE 8-22-25.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: 218	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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

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.