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Federal forms, ICRs, and supporting documents

OMB control number

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)

OMB 2900-0116 ยท VA.

OMB 2900-0116

VA Form 21-4193 is used to gather information from penal institutions about incarcerated VA beneficiaries. When beneficiaries are incarcerated in penal institutions in excess of 60 days after conviction, VA benefits are reduced or terminated. Without this collection of information, VA would be unable to accurately adjust the rates of incarcerated beneficiaries and overpayments would result.

The latest form for Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) expires 2028-12-31 and is listed under ICR 202506-2900-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form VBA-21-4193 NOTICE TO DEPARTMENT OF VETERANS AFFAIRS OF VETERAN OR BENEFICIARY INCARCERATED IN PENAL INSTITUTIONForm
Form VBA-21-4193 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193)Form
30-Day (published) 2900-0116.pdfSupplementary Document
VA-2025-VACO-0001-0056.pdfPublic Comments
VA-2025-VACO-0001-0055.pdfPublic Comments
2025-11957, 60-Day FRN (2900-0116, VAF21-4193).pdfSupplementary Document
2900-0116, Supporting Statement 8-28-25.docxSupporting Statement A
Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) Form
Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution (VA Form 21-4193) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202506-2900-007 Revision of a currently approved collection 2025-08-28
202207-2900-001 Reinstatement with change of a previously approved collection 2022-09-19 Approved without change
201612-2900-015 Extension without change of a currently approved collection 2017-06-30 Approved without change
201307-2900-015 Revision of a currently approved collection 2014-03-21 Approved without change
201009-2900-016 Extension without change of a currently approved collection 2011-01-03 Approved without change
200709-2900-021 Extension without change of a currently approved collection 2008-01-07 Approved without change
200505-2900-006 Extension without change of a currently approved collection 2005-05-11 Approved without change
200203-2900-011 Extension without change of a currently approved collection 2002-03-29 Approved without change
199907-2900-004 Reinstatement without change of a previously approved collection 1999-07-12 Approved without change
199508-2900-042 Extension without change of a currently approved collection 1995-08-28 Withdrawn and continue
199307-2900-007 Extension without change of a currently approved collection 1993-07-01 Approved without change
199008-2900-003 Extension without change of a currently approved collection 1990-08-10 Approved without change
198905-2900-020 No material or nonsubstantive change to a currently approved collection 1989-05-05 Approved with change
198709-2900-029 Extension without change of a currently approved collection 1987-09-28 Approved without change
198411-2900-004 Reinstatement with change of a previously approved collection 1984-11-09 Approved without change
198311-2900-010 Revision of a currently approved collection 1983-11-25 Approved without change
198102-2900-012 No material or nonsubstantive change to a currently approved collection 1981-02-19 Approved with change
198012-2900-010 Revision of a currently approved collection 1980-12-22 Approved without change
198011-2900-082 No material or nonsubstantive change to a currently approved collection 1980-11-06 Approved with change
197711-2900-001 Revision of a currently approved collection 1977-11-15 Approved without change