Veteran's Application for Compenstion;Authorization and Consent to Release Information to the Department of Veterans Affairs

Forms and Documents

Document Name	Status
Form VA Form 21-526 and Veteran's Application for Compenstion; Authorization and Consent to Release Information to the Department of Veterans Affairs Form and Instruction	Modified
2900-0001 justification.doc Supporting Statement A	2007-01-08

IC Document Collections

IC ID	Document Title	Status
28062	Veteran's Application for Compenstion; Authorization and Consent to Release Information to the Department of Veterans Affairs Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0001	ICR Reference No: 200701-2900-004
Status: Historical Active	Previous ICR Reference No: 200311-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0001
Title: Veteran's Application for Compenstion;Authorization and Consent to Release Information to the Department of Veterans Affairs
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2007
	Date Received in OIRA: 01/11/2007
Terms of Clearance: Approved consistent with the following terms of clearance: in the next submission of this collection to OMB for review VA shall report on the status of Dept. efforts to provide respondents with a completely electronic process for the completion and submission of associated VA forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved	02/28/2007
Responses	395,000	0	395,000
Time Burden (Hours)	592,500	0	592,500
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-526 is used as an original application for veterans to apply for compensation and/or pension benefits. VA Form 21-4142 is completed by veterans seeking VA's help in obtaining non-VA medical records.

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Authorizing Statute(s): US Code: 38 USC Section 5101 Name of Law: Claims and forms
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 211	11/01/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 4	01/08/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Veteran's Application for Compenstion; Authorization and Consent to Release Information to the Department of Veterans Affairs	VA Form 21-526 and 21-4142	Veteran's Application for Compensation;Authorization and Consent to Release to the Department of Veterans Affairs

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	395,000	395,000	0	0	0	0
Annual Time Burden (Hours)	592,500	592,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $14,465,798

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/11/2007

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