OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)

IC 28927 under ICR 202305-2900-006 · OMB 2900-0652.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.351 38 CFR 3.551

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0779 Request for Nursing Home Information in Connection with Claim for Aid and Attendance 21-0779(8-4-23).pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Veterans Readiness and Employment Records-VA (58VA21/22/28)  88 FR 16751

17,367 0
   
Private Sector Businesses or other for-profits
 
   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 17,367 0 -43,758 0 0 61,125
Annual IC Time Burden (Hours) 2,895 0 -7,293 0 0 10,188
Annual IC Cost Burden (Dollars) 0 0 -201,519 0 0 201,519

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.