OMB control number

Disability Benefits Questionnaires (Group 4)

OMB 2900-0781 · VA.

OMB 2900-0781

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form VA Form 21-0960Q-1 Chronic Fatigue Syndrome Disability Benefits Questionnaire	Form
Form VA Form 21-0960N-4 Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx Disability Benefits Questionnaire	Form
Form VA Form 21-0960N-3 Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire	Form
Form VA Form 21-0960L-1 Respiratory Conditions (Other than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire	Form
Form VA Form 21-0960J-4 Urinary Tract (Including Bladder and Urethra Conditions) (Excluding Male Reproductive System Disability Benefits Questionnaire	Form
Form VA Form 21-0960I-5 Nutritional Deficiencies Disability Benefits Questionnaire	Form
Form VA Form 21-0960I-4 Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases Disability Benefits Questionnaire	Form
Form VA Form 21-0960I-3 Infectious Diseases (Other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis) Disability Benefits Questionnaire	Form
Form VA Form 21-0960I-2 HIV-Related Illnesses Disability Benefits Questionnaire	Form
Form VA Form 21-0960H-1 Hernias (Including Abdominal, Inguinal and Femoral Hernias) Disability Benefits Questionnaire	Form
Form VA Form 21-0960E-3 Thyroid and Parathyroid Conditions	Form
Form VA Form 21-0960E-2 Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus) Disability Benefits Questionnaire	Form
Form VA Form 21-0960D-1 Oral and Dental Conditions Including Mouth, Lips and Tongue (Other than Temporomandibular Joint Conditions) Disability Benefits Questionnaire	Form
Form VA Form 21-0960C-1 Seizure Disorders (Epilepsy) Disability Benefits Questionnaire	Form
Form VA Form 21-0960C-7 Fibromyalgia Disability Benefits Questionnaire	Form
Form VA Form 21-0960C-6 Narcolepsy Disability Benefits Questionnaire	Form
Form VA Form 21-0960C-3 Cranial Nerves Diseases Disability Benefits Questionnaire	Form
Supporting Statement (2900-0781).docx	Supporting Statement A
2019-16024.pdf	Supplementary Document
2019-09203.pdf	Supplementary Document
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form
Disability Benefits Questionnaires (Group 4)	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
201903-2900-012	Extension without change of a currently approved collection	2019-10-01	Approved without change
201511-2900-002	Revision of a currently approved collection	2016-05-11	Approved without change
201406-2900-015	Revision of a currently approved collection	2015-01-05	Approved without change
201101-2900-014	New collection (Request for a new OMB Control Number)	2012-01-09	Approved without change