Information Collection

Residency Verification Report-Veterans and Survivors (FL21-914)

IC 28931 under ICR 202309-2900-008 · OMB 2900-0655.

Documents and Forms

Document Name Document Type
Form VA FL 21-914 Residency Verification Report-Veterans and Survivors (FL21-914) Form
VA FL 21-914 Residency Verification Report - Veterans and Survivors FL 21-914(9-26-23).pdf www.va.gov/vaforms Form
VA FL 21-914 Residency Verification Report - Veterans and Survivors FL 21-914(9-26-23).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Residency Verification Report-Veterans and Survivors (FL21-914)	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 3.42

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA FL 21-914	Residency Verification Report - Veterans and Survivors	FL 21-914(9-26-23).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 Veteran Readiness and Employment Records - VA	FR Citation: 88 FR 26548

Number of Respondents: 900	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	900	-350	1,250
Annual IC Time Burden (Hours)	75	-342	417
Annual IC Cost Burden (Dollars)	0	-613	613

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.