View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Decision Review Request: Supplemental Claim (VA Form 20-0995)	Agency IC Tracking Number:	VBA-OAR-YA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.2501

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	20-0995			https://www.vba.va.gov/pubs/forms/VBA-20-0995-ARE.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58/VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records	FR Citation: 84 FR 4138

Number of Respondents: 265,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	265,000	0	0	0	0	265,000
Annual IC Time Burden (Hours)	66,250	0	0	0	0	66,250
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
White Paper for OMB justifying non-sub change		08/18/2022

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

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