OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Report of Accidental Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident (21P-4176)

OMB 2900-0104 · VA.

OMB 2900-0104

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 21P-4176 Report of Accidental Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident (21P-4176)Form
30-Day FRN (2900-0104).pdf Supplementary Document
60-Day FRN (2900-0104).pdf Supplementary Document
OMB2900-0104(21P-4176)(11-20-14).docxSupporting Statement A
Report of Accidental Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident (21P-4176) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201405-2900-002 Revision of a currently approved collection 2014-12-02 Approved without change
201107-2900-021 Extension without change of a currently approved collection 2011-12-22 Approved without change
200805-2900-008 Extension without change of a currently approved collection 2008-11-25 Approved without change
200603-2900-003 Extension without change of a currently approved collection 2006-03-08 Approved without change
200304-2900-001 Revision of a currently approved collection 2003-04-02 Approved without change
200211-2900-003 Extension without change of a currently approved collection 2002-11-08 Withdrawn and continue
200003-2900-006 Reinstatement without change of a previously approved collection 2000-03-06 Approved without change
199611-2900-004 Extension without change of a currently approved collection 1996-11-05 Approved without change
199311-2900-007 Revision of a currently approved collection 1993-11-19 Approved without change
199010-2900-001 Extension without change of a currently approved collection 1990-10-01 Approved without change
198709-2900-025 Extension without change of a currently approved collection 1987-09-24 Approved without change
198409-2900-008 Reinstatement with change of a previously approved collection 1984-09-28 Approved without change
198107-2900-014 Extension without change of a currently approved collection 1981-07-01 Approved without change
198011-2900-081 No material or nonsubstantive change to a currently approved collection 1980-11-06 Approved with change
197609-2900-005 Revision of a currently approved collection 1976-09-07 Approved without change