Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)

ICR 202512-2900-007 · OMB 2900-0826 · Received in OIRA

Forms and Documents

Document	Type	Status	Availability
Form 21-0966 Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC	Form	Modified	Available
Comment-Response1, VAF21-0966 (2900-0826).docx	Public Comments	Uploaded 2026-02-26	Repair queued
Comment-Response2, VAF21-0966 (2900-0826) (1).docx	Public Comments	Uploaded 2026-02-26	Repair queued
30-Day FRN (published) 2900-0826.pdf	Supplementary Document	Uploaded 2026-02-26	Repair queued
VA-2025-VACO-0001-0137 2900-0826 2.pdf	Public Comments	Uploaded 2025-12-16	Available
VA-2025-VACO-0001-0151 2900-0826 1.pdf	Public Comments	Uploaded 2026-02-13	Repair queued
60-Day FRN (published) 2900-0826.pdf	Supplementary Document	Uploaded 2026-02-19	Available
2900-0826, Supporting Statement (VAF21-0966) 1.docx	Supporting Statement A	Uploaded 2026-02-26	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
212535	Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)	Form	Modified	Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC
212535	Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)	Form	Modified

ICR Details

OMB Control No: 2900-0826	ICR Reference No: 202512-2900-007
Status: Received in OIRA	Previous ICR Reference No: 202111-2900-007
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-KM
Title: Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	701,272	409,394
Time Burden (Hours)	58,439	102,348
Cost Burden (Dollars)	0	0

Abstract: VA Form 21-0966 is used to gather the necessary information to determine an effective date for an award granted in association with a complete claim filed within one year of such form. VA also uses it as a request for application and responds by mailing the claimant a letter of receipt, along with the appropriate VA form or application for VA benefits. Without this information, determination of entitlement would not be possible.

Authorizing Statute(s): US Code: 38 USC 5102 Name of Law: Application forms furnished upon request; notice to claimants of incomplete applications

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58372	12/16/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 9695	02/26/2026
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)	21-0966	Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	701,272	409,394	291,878
Annual Time Burden (Hours)	58,439	102,348	-43,909
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The previous burden estimate is incorrect. The previous annual time burden should state: 409,394 x 5 min / 60 = 34,116. As such, this proposed estimation of 58,439 is an increase. The respondent burden has increased due to the estimated number of receivables averaged over the past year.

Annual Cost to Federal Government: $7,890,699

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Dorothy Glasgow 240 205-5190 [email protected]

Common Form ICR: No