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Information Collection

Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (21P-8416b)

IC 28721 under ICR 202402-2900-015 · OMB 2900-0545.

Documents and Forms
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Information Collection (IC) Details

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Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death (21P-8416b) 2900-0545
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.262 38 CFR 3.272 38 CFR 3.271

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21P-8416b Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death VA Form 21P-8416b -New Burden Statement (508 Conformant 6-20-23) 3-28-24.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)  84 FR 38

100 0
   
Individuals or Households
 
   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 100 0 -1,400 0 0 1,500
Annual IC Time Burden (Hours) 75 0 -1,050 0 0 1,125
Annual IC Cost Burden (Dollars) 2,232 0 -26,703 0 0 28,935

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