Information Collection

Status of Dependents Questionnaire

IC 28684 under ICR 201307-2900-016 · OMB 2900-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0500 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0538 Status of Dependents Questionnaire Form
VA Form 21-0538 Status of Dependents Questionnaire 21-0538(1-14).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Status of Dependents Questionnaire	Agency IC Tracking Number:	2900-0500 VBA-COMP-NK

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.652

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0538	Status of Dependents Questionnaire	21-0538(1-14).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: 84,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	84,500	0	84,500
Annual IC Time Burden (Hours)	14,083	0	14,083
Annual IC Cost Burden (Dollars)	211,245	211,245	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.