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OMB Control No: 2900-0826	ICR Reference No: 202512-2900-007
Status: Received in OIRA	Previous ICR Reference No: 202111-2900-007
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-KM
Title: Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2026
Responses	701,272	409,394
Time Burden (Hours)	58,439	102,348
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	701,272	409,394	291,878
Annual Time Burden (Hours)	58,439	102,348	-43,909
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The previous burden estimate is incorrect. The previous annual time burden should state: 409,394 x 5 min / 60 = 34,116. As such, this proposed estimation of 58,439 is an increase. The respondent burden has increased due to the estimated number of receivables averaged over the past year.

Annual Cost to Federal Government: $7,890,699

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Dorothy Glasgow 240 205-5190 dorothy.glasgow@va.gov

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