Information Collection

Fiduciary Agreement (VA Form 21P-4703)

IC 28528 under ICR 202012-2900-002 · OMB 2900-0319.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0319 can be found here:

Documents and Forms

Document Name Document Type
Form 21P-4703 Fiduciary Agreement (VA Form 21P-4703) Form
21P-4703 Fiduciary Agreement VA Form 21P-4703-NEW REGS VERSION (12-08-2020).pdf www.va.gov/vaforms Form
21P-4703 Fiduciary Agreement VA Form 21P-4703-NEW REGS VERSION (12-08-2020).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Fiduciary Agreement (VA Form 21P-4703)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 38 CFR 13.140

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21P-4703	Fiduciary Agreement	VA Form 21P-4703-NEW REGS VERSION (12-08-2020).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, and Vocational Rehabilitation and Employment Records - VA	FR Citation: 84 FR 4138

Number of Respondents: 47,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	47,000	47,000
Annual IC Time Burden (Hours)	3,917	3,917
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.