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OMB Control No: 2900-0829	ICR Reference No: 202607-2900-011
Status: Received in OIRA	Previous ICR Reference No: 202309-2900-002
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-KM
Title: Income and Asset Statement in Support of Claim for Pension or Parents' DIC (VA Form 21P-0969)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/20/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2026
Responses	55,000	55,000
Time Burden (Hours)	27,500	27,500
Cost Burden (Dollars)	1,796,300	818,400

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	55,000	55,000	0
Annual Time Burden (Hours)	27,500	27,500	0
Annual Cost Burden (Dollars)	1,796,300	818,400	977,900

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: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $2,766,189

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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