Information Collection

Alternate Signer Certification

IC 220635 under ICR 202512-2900-006 · OMB 2900-0849.

Documents and Forms

Document Name Document Type
Form 21-0972 Alternate Signer Certification Alternate Signer Certification Form
21-0972 Alternate Signer Certification VBA-21-0972 2-26-26.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Alternate Signer Certification	Agency IC Tracking Number:	2900-0849

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0972	Alternate Signer Certification	VBA-21-0972 2-26-26.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education, and Veterans Readiness and Employment Records	FR Citation: 87 FR 8740

Number of Respondents: 22,278	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	22,278	3,703	18,575
Annual IC Time Burden (Hours)	5,570	926	4,644
Annual IC Cost Burden (Dollars)	0	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.

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