Information Collection

Veteran's Application for Compensation and/ or Pension; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application

IC 28062 under ICR 201412-2900-015 · OMB 2900-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0001 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-526 Veteran's Application for Compensation and/ or Pension; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application Form
VA Form 21-526 Application for Compensation and/or Pension 21-526(12-19-14-P&F).pdf www.va.gov/vaforms Form
VA Form 21-526b Veteran's Supplemental Claim for Compensation 21-526b(12-30-14).pdf www.va.gov/vaforms Form
VA Form 21-4142 Authorization to Disclose Information to the Department 21-4142(12-30-14).pdf www.va.gov/vaforms Form
VA Form 21-4142a General Release for Medical Provider Information to the 21-4142a(12-30-14).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Veteran's Application for Compensation and/ or Pension; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application	Agency IC Tracking Number:	2900-0001

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-526	Application for Compensation and/or Pension	21-526(12-19-14-P&F).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-526b	Veteran's Supplemental Claim for Compensation	21-526b(12-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-4142	Authorization to Disclose Information to the Department of Veterans Affairs (VA)	21-4142(12-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-4142a	General Release for Medical Provider Information to the Department of Veterans Affairs (VA)	21-4142a(12-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 433,433	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	433,433	433,433
Annual IC Time Burden (Hours)	149,182	149,182
Annual IC Cost Burden (Dollars)	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.