Information Collection

Statement in Support of Claim for Service Connection for PTSD (21-0781), Statement in Support of Claim for Service Connection for PTSD(VA Form 21-0781a)

IC 28937 under ICR 201309-2900-018 · OMB 2900-0659.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0659 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0781a Statement in Support of Claim for Service Connection for PTSD (21-0781), Statement in Support of Claim for Service Connection for PTSD(VA Form 21-0781a) Form
VA Form 21-0781a Statement in Support of Claim for Service Connection for 21-0781a(4-14).pdf www.va.gov/vaforms Form
VA Form 21-0781 Statement in Support of Claim for Service Connection for 21-0781(4-14).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement in Support of Claim for Service Connection for PTSD (21-0781), Statement in Support of Claim for Service Connection for PTSD(VA Form 21-0781a)	Agency IC Tracking Number:	2900-0659 VBA-COMP-NK

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 3.304(f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0781a	Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault	21-0781a(4-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-0781	Statement in Support of Claim for Service Connection for Post Traumatic Stress Disorder (PTSD)	21-0781(4-14).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: 15,240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,240	15,240
Annual IC Time Burden (Hours)	17,780	17,780
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.