Information Collection

Application Request to Add and/or Remove Dependents (VA Form 21-686c)

IC 28162 under ICR 201808-2900-002 · OMB 2900-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0043 can be found here:

Documents and Forms

Document Name Document Type
Form 21-686c Application Request to Add and/or Remove Dependents (VA Form 21-686c) Form
21-686c Application Request to Add and/or Remove Dependents VAF 21-686c (FINAL).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Request to Add and/or Remove Dependents (VA Form 21-686c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.205 38 CFR 3.209

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-686c	Application Request to Add and/or Remove Dependents	VAF 21-686c (FINAL).pdf	www.va.gov/vaforms	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 226,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	226,000	0	226,000
Annual IC Time Burden (Hours)	113,000	56,500	56,500
Annual IC Cost Burden (Dollars)	0	0	0

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.