Information Collection

Request for Contact Information (FL21P-30)

IC 28938 under ICR 202009-2900-009 · OMB 2900-0660.

Documents and Forms

Document Name Document Type
Form VA Form FL21-30 Request for Contact Information (FL21P-30) Form
VA Form FL21-30 Request for Contact Information FL21-30(2-22-21).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Contact Information (FL21P-30)	Agency IC Tracking Number:	2900-0660

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form FL21-30	Request for Contact Information	FL21-30(2-22-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28 Compensation, Pension, Education, Vocational Rehabilitation and Employment Records -VA	FR Citation: 86 FR 7527

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	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.