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Federal forms, ICRs, and supporting documents

Information Collection

Disability Benefits Questionnaires

IC 193056 under ICR 201610-2900-005 · OMB 2900-0749.

Documents and Forms
Document Name
Document Type
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Form
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Form
Information Collection (IC) Details

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Disability Benefits Questionnaires
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.326 38 CFR 3.351d 38 CFR 3.351e

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960A-1 Ischemic Heart Disease (IHD) Disability Benefits Questionnaire 21-0960A-1.pdf www.va,gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960B-1 Hairy Cell and Other B-Cell Leukemias Disability Benefits Questionnaire VBA-21-0960B-1-ARE 11-02-2016.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-1 Parkinson's Disease Disability Benefits Questionnaire VBA-21-0960C-1-ARE 11-02-2016.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

 

62,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 62,000 0 0 0 0 62,000
Annual IC Time Burden (Hours) 15,500 0 0 0 0 15,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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