Title:Supplemental Income Questionnaire (For Philippine Claims Only), VA Form 21-0784.
OMB Control Number:2900-0668.
Type of Review:Extension of a currently approved collection.
Abstract:Claimants residing in the Philippines complete VA Form 21-0784 to report their countable family income and net worth. VA uses the information to determine the claimant's entitlement to pension benefits.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. TheFederal RegisterNotice with a 60-day comment period soliciting comments on this collection of information was published on March 25, 2011, at page 16858.
Affected Public:Individuals or households.
Estimated Annual Burden:30 hours.
Estimated Average Burden per Respondent:15 minutes.
Frequency of Response:One time.
Estimated Number of Respondents:120.
Dated: June 2, 2011.
By direction of the Secretary.
Program Analyst, Enterprise Records Service.