Information Collection

Status of Dependents Questionnaire

IC 28684 under ICR 201406-2900-021 · 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⚠️ Notice: This information collection may be referencing outdated material.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 VA Form 21-0538 (DOMA - 6-18-14).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

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	VA Form 21-0538 (DOMA - 6-18-14).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	Previously Approved
Annual Number of Responses for this IC	84,500	84,500
Annual IC Time Burden (Hours)	14,083	14,083
Annual IC Cost Burden (Dollars)	211,245	211,245

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.