Information Collection

Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

IC 214403 under ICR 202607-2900-011 · OMB 2900-0829.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21p-0969 Income and Asset Statement in Support of Claim for Pension or Parent's Dependency and Indemnity Compensation (D.I.C.) Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)	Form
21p-0969 Income and Asset Statement in Support of Claim for Pensi VBA-21P-0969-ARE 10-1-26.pdf	Form

IC Title:

Agency IC Tracking Number:

2900-0829

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.5 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	21p-0969			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: 55,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55,000	0	55,000
Annual IC Time Burden (Hours)	27,500	0	27,500
Annual IC Cost Burden (Dollars)	1,796,300	977,900	818,400

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].