OMB control number
Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)
OMB 2900-0829 ยท VA.
OMB 2900-0829
VA Form 21P-0969 will be used by claimants for VA Pension or Parents' Dependency and Indemnity Compensation (DIC) to provide information pertaining to income and assets to establish entitlement to Pension or Parents' DIC. This form will be completed only by those claimants who had income other than Social Security benefits during the calendar year before claiming benefits or who disposed of assets or have significant assets which may affect their entitlement to needs-based benefits.
The latest form for Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) expires 2026-11-30 and is listed under ICR 202309-2900-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 21P-0969 Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) | Form and Instruction |
 FRN Correction Notice (2900-0829) 9-15-23.docx | Supplementary Document |
| 30-Day FRN - 2900-0829 (2023) 2.pdf | Supplementary Document |
| OMB 2900-0829 Withdrawn 30-day FRN (9-29-23).pdf | Supplementary Document |
| 60-Day FRN Published (2900-0829, 0969).pdf | Supplementary Document |
| 2900-0829, SS (VAF 21P-0969), 20231004.docx | Supporting Statement A |
 Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202309-2900-002 | Revision of a currently approved collection | 2023-10-04 | Approved with change | |
| 202306-2900-023 | Revision of a currently approved collection | 2023-09-15 | Improperly submitted and continue | |
| 202108-2900-017 | Reinstatement with change of a previously approved collection | 2021-11-04 | Approved without change | |
| 201809-2900-003 | New collection (Request for a new OMB Control Number) | 2018-09-18 | Approved with change | |
| 201412-2900-019 | New collection (Request for a new OMB Control Number) | 2015-01-02 | Comment filed on proposed rule |