Information Collection

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution

IC 28320 under ICR 200709-2900-021 · OMB 2900-0116.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0116 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-4193 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution Form
VA Form 21-4193 Notice to Department of Veterans Affairs of Veteran or B 21-4193.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution	Agency IC Tracking Number:	2900-0116

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-4193	Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution	21-4193.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,664	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,664	1,664
Annual IC Time Burden (Hours)	416	416
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.