Information Collection

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

IC 212535 under ICR 202512-2900-007 · OMB 2900-0826.

Documents and Forms

Document Name Document Type
Form 21-0966 Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966) Form
21-0966 Intent to File a Claim for Compensation and/or Pension o 21-0966 2-26-26.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)	Agency IC Tracking Number:	2900-0826

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.155

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-0966	Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC	21-0966 2-26-26.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, Veterans Readiness and Employment Records - VA	FR Citation: 87 FR 8740

Number of Respondents: 701,272	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

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

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