OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Disability Benefits Questionnaires (Group 3)

IC 196002 under ICR 201511-2900-001 · OMB 2900-0778.

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Information Collection (IC) Details

View Information Collection (IC)

Disability Benefits Questionnaires (Group 3)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 21-0960C-5 CENTRAL NERVOUS SYSTEM AND NEUROMUSCULAR DISEASES VA Form 21-0960C-5 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-8 HEADACHES (INCLUDING MIGRAINE HEADACHES) VA Form 21-0960C-8 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-9 MULTIPLE SCLEROSIS (MS) VA Form 21-0960C-9 (1-13-16).pdf www.va.gov/vafaorms Yes No Fillable Printable
Form VA Form 21-0960-G-1 ESOPHAGEAL CONDITIONS (Including gastroesophageal reflux disease (GERD), VA Form 21-0960G-1 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-2 GALLBLADDER AND PANCREAS CONDITIONS VA Form 21-0960G-2 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-3 INTESTINAL CONDITIONS (OTHER THAN SURGICAL OR INFECTIOUS)  VA Form 21-0960G-3 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-4 INTESTINAL SURGERY (BOWEL RESECTION, COLOSTOMY, ILEOSTOMY) DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960G-4 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-5 HEPATITIS, CIRRHOSIS AND OTHER LIVER CONDITIONS VA Form 21-0960G-5 (1-12-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-6 PERITONEAL ADHESIONS DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960G-6 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-7 STOMACH AND DUODENAL CONDITIONS (NOT INCLUDING GERD OR ESOPHAGEAL DISORDERS) DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960G-7 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960G-8 INFECTIOUS INTESTINAL DISORDERS, INCLUDING BACTERIAL AND VA Form 21-0960G-8 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960H-2 RECTUM AND ANUS CONDITIONS (INCLUDING HEMORRHOIDS) DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960H-2 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960K-1 BREAST CONDITIONS AND DISORDERS DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960K-1 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960K-2 GYNECOLOGICAL CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960K-2 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960L-2 SLEEP APNEA DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960L-2 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-11 OSTEOMYELITIS DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960M-11 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-1 EAR CONDITIONS (INCLUDING VESTIBULAR AND INFECTIOUS CONDITIONS) DISABILITY BENEFITS QUESTIONNAIRE VA Form 21-0960N-1 (1-13-16).pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Rehabilitation Records—VA (58VA21/22/28)  74 FR 117

250,000 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 250,000 0 0 0 0 250,000
Annual IC Time Burden (Hours) 77,500 0 0 0 0 77,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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