Hand and Finger Conditions Disability Benefits Questionnaire (21-0960M-7)

ICR 201612-2900-009 · OMB 2900-0809 · Historical Inactive

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0809 can be found here:

2017-09-29 - Reinstatement without change of a previously approved collection

Forms and Documents

Document	Type	Status	Availability
Form VA Form 21-0960M-7 Hand and Finger Conditions Disability Benefits Questionnaire (21-0960M-7)	Form	Modified	Available
30-Day FRN - 2900-0809 (2017).pdf	Supplementary Document	Uploaded 2017-04-19	Repair queued
60-day FRN - 2900-0809 (2017).pdf	Supplementary Document	Uploaded 2017-04-12	Repair queued
2900-0809, Supporting Statement (21-0960M-7).docx	Supporting Statement A	Uploaded 2017-06-26	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
206560	Hand and Finger Conditions Disability Benefits Questionnaire (21-0960M-7)	Form	Modified

ICR Details

OMB Control No: 2900-0809	ICR Reference No: 201612-2900-009
Status: Historical Inactive	Previous ICR Reference No: 201304-2900-013
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: Hand and Finger Conditions Disability Benefits Questionnaire (21-0960M-7)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 09/29/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/26/2017
Terms of Clearance: VA withdraws this collection to make a technical correction to the way it was submitted.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	30,000	0	0
Time Burden (Hours)	15,000	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The form will be used to gather necessary information from a claimant's treating physician regarding the results of medical examinations. VA will gather medical information related to the claimant that is necessary to adjudicate the claim for VA disability benefits.

Authorizing Statute(s): US Code: 38 USC 501(a) Name of Law: Rules and Regulations

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 12912	03/07/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 18538	04/19/2017
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Hand and Finger Conditions Disability Benefits Questionnaire (21-0960M-7)	VA Form 21-0960M-7	Hand and Finger Conditions Disability Benefits Questionnaire

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $2,639,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Cynthia Harvey - Pryor 202 461-5870 [email protected]

Common Form ICR: Yes
Description/Changes for Common Form Usage:

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title