View Information Collection (IC)

View Information Collection (IC)

Disability Benefits Questionnaires (Group 2) 2900-0776
 
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 21-0960A-3 Hypertension DBQ 21-0960A-3.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-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-10 Muscle Injuries DBQ 21-0960M-10.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-6 Foot Miscellaneous (Other than Flatfoot/Pes Planus) Disability Benefits Questionnaire 21-0960M-6.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-2 Ankle Conditons Disability Benefits Questionnaire 21-0960M-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-12 Shoulder and Arm Conditions Disability Benefits Questionnaire 21-0960M-12.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-2 Artery and Vein Conditions (Vascular Diseases including Varicose Veins) Disability Benefits Questionnaire 21-0960A-2.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-5 Flatfoot (Pes Planus) Disability Benefits Questionnaire 21-0960M-5.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960F-1 Scars/Disfigurement Disability Benefits Questionnaire 21-0960F-1.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-16 Wrist Conditions Disability Benefits Questionnaire 21-0960M-16.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-15 Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire 21-0960M-15.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-7 Hand and Finger Conditions Disability Benefits Questionnaire 21-0960M-7.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-8 Hip and Thigh Conditions Disability Benefits Questionnaire 21-0960M-8.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-9 Knee and Lower Leg Conditions Disability Benefits Questionnaire 21-0960M-9.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960A-4 Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire 21-0960A-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire 21-0960C-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960M-4 Elbow and Forearm Conditions Disability Benefits Questionnaire 21-0960M-4.pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 21-0960N-2 Eye Conditions Disability Benefits Questionnaire 21-0960N-2.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

 

725,000 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 725,000 0 0 0 0 725,000
Annual IC Time Burden (Hours) 311,250 0 0 0 0 311,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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