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Federal forms, ICRs, and supporting documents

Information Collection

Disability Benefits Questionnaires (Group I )

IC 195776 under ICR 201712-2900-008 · OMB 2900-0779.

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Information Collection (IC) Details

View Information Collection (IC)

Disability Benefits Questionnaires (Group I ) VBA-COMP-DJ&YA
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.351 38 CFR 3.326

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960B-2 Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire VAF 21-0960B-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960J-2 Male Reproductive Organ Conditions Disability Benefits Questionnaire VAV 21-0960J-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-1 Persian Gulf and Afghanistan Infectious Diseases Disability Benefits Questionnaire VAF 21-0960I-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960I-6 Tuberculosis Disability Benefits Questionnaire VAF 21-0960I-6.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-2 Amotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire VAF 21-0960C-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-10 Peripheral Nerves Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire VAF 21-0960C-10.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960J-1 Kidney Conditions (Nephrology) Disability Benefits Quesionnaire VAF 21-0960J-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960P-1 Eating Disorders Disability Benefits Quesitonnaire VAF 21-0960P-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960P-2 Mental Disorders (Other than PTSD and Eating Disorders) Disability Benefits Questionnaire VAF 21-0960P-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire VAF 21-0960P-3.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960J-3 Prostate Cancer Disability Benefits Questionnaire VAF 21-0960J-3.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 80

307,000 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 307,000 0 0 0 307,000 0
Annual IC Time Burden (Hours) 127,917 0 0 0 127,917 0
Annual IC Cost Burden (Dollars) 3,070,008 0 -3,052,099 3,052,099 3,070,008 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.