OMB control number

Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)

OMB 2900-0829 · VA.

OMB 2900-0829

VA Form 21P-0969 will be used by claimants for VA Pension or Parents' Dependency and Indemnity Compensation (DIC) to provide information pertaining to income and assets to establish entitlement to Pension or Parents' DIC. This form will be completed only by those claimants who had income other than Social Security benefits during the calendar year before claiming benefits or who disposed of assets or have significant assets which may affect their entitlement to needs-based benefits.

The latest form for Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) expires 2026-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 21P-0969 Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) Form and Instruction
FRN Correction Notice (2900-0829) 9-15-23.docx Supplementary Document
30-Day FRN - 2900-0829 (2023) 2.pdf Supplementary Document
OMB 2900-0829 Withdrawn 30-day FRN (9-29-23).pdf Supplementary Document
60-Day FRN Published (2900-0829, 0969).pdf Supplementary Document
2900-0829, SS (VAF 21P-0969), 20231004.docx Supporting Statement A
Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969) Form and Instruction

All Historical Document Collections

202309-2900-002 Approved with change	Revision of a currently approved collection	2023-10-04
202306-2900-023 Improperly submitted and continue	Revision of a currently approved collection	2023-09-15
202108-2900-017 Approved without change	Reinstatement with change of a previously approved collection	2021-11-04
201809-2900-003 Approved with change	New collection (Request for a new OMB Control Number)	2018-09-18
201412-2900-019 Comment filed on proposed rule	New collection (Request for a new OMB Control Number)	2015-01-02