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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
DBQs
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 21-0960A-2
Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) DBQ
21-0960A-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960A-3
Hypertension DBQ
21-0960A-3.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960A-4
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) DBQ
21-0960A-4.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960C-4
Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) DBQ
21-0960C-4.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960E-1
Diabetes Mellitus DBQ
21-0960E-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960F-1
Scars/Disfigurement DBQ
21-0960F-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960F-2
Skin Diseases DBQ
21-0960F-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-1
Amputations DBQ
21-0960M-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-2
Ankle Conditions DBQ
21-0960M-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-4
Elbow and Forearm Conditions DBQ
21-0960M-4.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-5
Flatfoot (Pes Planus) DBQ
21-0960M-5.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-6
Foot Miscellaneous (Other than Flatfoot/Pes Planus) DBQ
21-0960M-6.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-7
Hand and Finger Conditions DBQ
21-0960M-7.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-8
Hip and Thigh Conditions DBQ
21-0960M-8.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-9
Knee and Lower Leg Conditions DBQ
21-0960M-9.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-10
Muscle Injuries DBQ
21-0960M-10.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-12
Shoulder and Arm Conditions DBQ
21-0960M-12.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-15
Temporomandibular Joint Conditions DBQ
21-0960M-15.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-16
Wrist Conditions DBQ
21-0960M-16.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960N-2
Eye Conditions DBQ
21-0960N-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Legislative Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
725,000
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
725,000
0
725,000
0
0
0
Annual IC Time Burden (Hours)
311,250
0
311,250
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.