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Federal forms, ICRs, and supporting documents

Information Collection

Disability Benefits Questionnaires (Group 2)

IC 195946 under ICR 201711-2900-012 · OMB 2900-0776.

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Information Collection (IC) Details

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Disability Benefits Questionnaires (Group 2) 2900-0776 VBA-COMP-DB
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960A-2 Artery and Vein Conditions (Vascular Diseases including Varicose Veins) Disability Benefits Questionnaire 21-0960A-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960F-1 Scars/Disfigurement Disability Benefits Questionnaire 21-0960F-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-15 Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire 21-0960M-15.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-4 Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire 21-0960A-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire 21-0960C-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-2 Eye Conditions Disability Benefits Questionnaire 21-0960N-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-3 Hypertension Disability Benefits Questionnaire 21-0960A-3.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-1 Amputations Disability Benefits Questionnaire 21-0960M-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960F-2 Skin Diseases Disability Benefits Questionnaire 21-0960F-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-10 Muscle Injuries Disability Benefits Questionnaire 21-0960M-10.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960E-1 Diabetes Mellitus Disability Benefits Questionnaire 21-0960E-1.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  75 FR 22187

400,000 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 400,000 0 0 0 400,000 0
Annual IC Time Burden (Hours) 162,500 0 0 0 162,500 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.