Information Collection

Alternate Signer Certification

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

2900-0849

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	21-0972			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 %

table that charts list of burden
	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

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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