Veteran's Application for Compensation; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application

Forms and Documents

Document Name	Status
Form VA Form 21-526b Veteran's Application for Compensation; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application Form	Modified
21-4142_Supplemental_Statement_(09-30-11)[1].docx Justification for No Material/Nonsubstantive Change	2011-10-11
2900-0001 justification.doc Supporting Statement A	2009-12-10

IC Document Collections

IC ID	Document Title	Status
28062	Veteran's Application for Compensation; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application Form	Modified

ICR Details

OMB Control No: 2900-0001	ICR Reference No: 201109-2900-009
Status: Historical Active	Previous ICR Reference No: 200909-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0001
Title: Veteran's Application for Compensation; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/13/2011
	Date Received in OIRA: 10/11/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	03/31/2013	03/31/2013
Responses	595,000	0	595,000
Time Burden (Hours)	441,982	0	441,982
Cost Burden (Dollars)	0	0	0

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Abstract: To determine eligibility for compensation and/or pension benefits.

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Authorizing Statute(s): US Code: 38 USC Section 5101(a) 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:
	74 FR 187	09/29/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 235	12/09/2009
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 Compensation; Authorization and Consent to Release Information to the DVA, Veteran's Supplemental Claim Application	VA Form 21-526b, VA Form 21-4142, VA Form 21-526	Veteran's Supplemental Claim Application ,   Authorization and Consent to Release Information to the Department of Veterans Affairs ,   Veteran's Application for Compensation and/or Pension

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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	595,000	595,000	0	0	0	0
Annual Time Burden (Hours)	441,982	441,982	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: Revision of the primary form will streamline the application process and reduce the amount of time required to complete the application for compensation or pension benefits.

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Annual Cost to Federal Government: $10,804,361

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]? 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? 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: 10/11/2011

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