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Federal forms, ICRs, and supporting documents

OMB control number

Pension Claim Questionnaire for Farm Income (VA Form 21P-4165)

OMB 2900-0095 · VA.

OMB 2900-0095

The VA Form 21P-4165 (Formerly VA Form 21-4165) is used to gather information which is necessary to determine a claimant's countable annual income and available assets related to farm operations. Eligibility to income-based benefits cannot be determined without complete income information.

The latest form for Pension Claim Questionnaire for Farm Income (VA Form 21P-4165) expires 2028-12-31 and is listed under ICR 202502-2900-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 21P-4165 Pension Claim Questionnaire for Farm IncomeForm and Instruction
Form 21P-4165 Pension Claim Questionnaire for Farm IncomeForm and Instruction
Public comment 2900-0095.docx (document unavailable)Public Comments
30-DAY (published) 2900-0095.pdfSupplementary Document
30-DAY (published) 2900-0095.pdf Supplementary Document
60-Day FRN (published) 2900-0095.pdfSupplementary Document
2900-0095 (21P-4165) - Supporting Statement 8-26-25.docxSupporting Statement A
Pension Claim Questionnaire for Farm Income Form and Instruction
Pension Claim Questionnaire for Farm Income Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202502-2900-011 Extension without change of a currently approved collection 2025-08-26
202204-2900-013 Revision of a currently approved collection 2022-07-19 Approved without change
201902-2900-003 Extension without change of a currently approved collection 2019-07-02 Approved without change
201604-2900-009 Revision of a currently approved collection 2016-07-26 Approved with change
201305-2900-015 Extension without change of a currently approved collection 2013-09-30 Approved without change
201009-2900-022 Extension without change of a currently approved collection 2010-12-23 Approved without change
200707-2900-029 Extension without change of a currently approved collection 2007-11-30 Approved without change
200410-2900-003 Extension without change of a currently approved collection 2004-10-22 Approved without change
200201-2900-001 Extension without change of a currently approved collection 2002-01-18 Approved without change
199811-2900-019 Reinstatement without change of a previously approved collection 1998-11-23 Approved without change
199508-2900-033 Extension without change of a currently approved collection 1995-08-28 Withdrawn and continue
199311-2900-004 Extension without change of a currently approved collection 1993-11-08 Approved without change
199008-2900-004 Extension without change of a currently approved collection 1990-08-10 Approved without change
198708-2900-007 Extension without change of a currently approved collection 1987-08-21 Approved without change
198407-2900-009 Revision of a currently approved collection 1984-07-30 Approved without change
198107-2900-045 No material or nonsubstantive change to a currently approved collection 1981-07-17 Approved with change
198101-2900-028 No material or nonsubstantive change to a currently approved collection 1981-01-29 Approved with change
198005-2900-004 Reinstatement without change of a previously approved collection 1980-05-07 Approved without change
197505-2900-002 Extension without change of a currently approved collection 1975-05-09 Approved without change