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Federal forms, ICRs, and supporting documents

Information Collection Request

VETERAN'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING VETERAN'S DEPENDENCY QUESTIONNAIRE

ICR 198205-2900-004 · OMB 2900-0309 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
174644 VETERAN'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING VETERAN'S DEPENDENCY QUESTIONNAIRE Form Migrated
ICR Details
2900-0309 198205-2900-004
Historical Active 198105-2900-003
VA
VETERAN'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING VETERAN'S DEPENDENCY QUESTIONNAIRE
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/12/1982
Approved with change 05/12/1982
Retrieve Notice of Action (NOA) 05/12/1982
  Inventory as of this Action Requested Previously Approved
07/31/1983 07/31/1983 07/31/1983
12,000 0 12,000
4,000 0 4,000
0 0 0
THIS FORM IS USED TO OBTAIN DEPENDENCY EVIDENCE FOR CONTINUED ENTITLEMENT FROM VETERANS (RECEIVING COMPENSATION FOR DISABILITIES RATED AT 30% OR MORE) BEING PAID ADDITIONAL COMPENSATION FOR DEPENDENT PARENTS.
None
None
No
1
IC Title Form No. Form Name
VETERAN'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING VETERAN'S DEPENDENCY QUESTIONNAIRE 21-4151 &, 21-4151A
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,000 12,000 0 0 0 0
Annual Time Burden (Hours) 4,000 4,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/12/1982