Information Collection

35% exemption Request From 85-15 Reporting Requirement

IC 248396 under ICR 202107-2900-004 · OMB 2900-0896.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0896 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 22-10216 35% exemption Request From 85-15 Reporting Requirement Form
VA Form 22-10216 35% Exemption Request From 85-15 Reporting Requirement 22-10216(2-23-21).pdf www.va.gov/vaforms Form
VA Form 22-10216 35% Exemption Request From 85-15 Reporting Requirement 22-10216(2-23-21).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	35% exemption Request From 85-15 Reporting Requirement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 22-10216	35% Exemption Request From 85-15 Reporting Requirement	22-10216(2-23-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education, Veteran Readiness and Employment Records - VA	FR Citation: 84 FR 4138

Number of Respondents: 1,000	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
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	500	500
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.