Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Disability Benefits Questionnaires (Group 3)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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 21-0960C-8
Headaches (including migraine headaches) Disability Benefits Questionnaire
21-0960C-8.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960C-9
Multiple Sclerosis (MS) Disability Benefits Questionnaire
21-0960C-9.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-1
Esophageal Disorders (including GERD) Disability Benefits Questionnaire
21-0960G-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-2
Gallbladder and Pancreas Conditions Disability Benefits Questionnaire
21-0960G-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960K-1
Breast Conditions and Disorders Disability Benefits Questionnaire
21-0960K-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960K-2
Gynecological Conditions Disability Benefits Questionnaire
21-0960K-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-11
Osteomyelitis Disability Benefits Questionnaire
21-0960M-11.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960L-2
Sleep Apnea Disability Benefits Questionnaire
21-0960L-2(2-11).pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-5
Hepatitis, Cirrhosis and other Liver Conditions Disability Benefits Questionnaire
21-0960G-5.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
21-0960G-7.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960M-3
Non-Degenerative Arthritis (Including inflammatory, Autoimmune, Crystalline and Infectious Arthritis) and Dysbaric Osteonecrosis Disability Benefits Questionnaire
21-0960M-3.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
21-0960N-1.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960H-2
Rectum and Anus Conditions Conditions (Including Hemorrhoids) Disability Benefits Questionnaire
21-0960H-2.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-6
Peritoneal Adhesions Disability Benefits Questionnaire
21-0960G-6.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-3
Intestinal Conditions (Other than Surgical or Infectious) (Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and Diverticulitis) Disability Benefits Questionnaire
21-0960G-3.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-4
Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy) Disability Benefits Questionnaire
21-0960G-4.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960C-5
Central Nervous System and Neuromuscular Diseases
21-0960C-5.pdf
www,va,gov/vaforms
Yes
No
Fillable Printable
Form
VA Form 21-0960G-8
Infectious Intestinal Disorders, Including Bacterial and Parasitic Infections Disability Benefits Questionnaire
21-0960G-8.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:
Compensation, Pension, Education, and Rehabilitation Records—VA (58VA21/22/28)
FR Citation:
74 FR 117
Number of Respondents:
350,000
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
350,000
0
0
0
0
350,000
Annual IC Time Burden (Hours)
102,500
0
0
0
0
102,500
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.