Mandatory Status of Dependents (21-0538)

Forms and Documents

Document Name	Status
Form 21-0538 Status of Dependents Questionnaire Form	Modified
2900-0500, Supporting Statement (21-0538).doc Supporting Statement A	2017-04-21
60-Day FRN (Published 01-23-17) OMB 2900-0500.pdf Supplementary Document	2017-01-26

IC Document Collections

IC ID	Document Title	Status
28684	Status of Dependents Questionnaire Form	Modified

ICR Details

OMB Control No: 2900-0500	ICR Reference No: 201609-2900-012
Status: Historical Inactive	Previous ICR Reference No: 201406-2900-021
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: Mandatory Status of Dependents (21-0538)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 09/29/2017
	Date Received in OIRA: 05/31/2017
Terms of Clearance: VA withdraws this collection to make a technical correction to the way it was submitted.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	12/31/2017
Responses	84,500	0	84,500
Time Burden (Hours)	14,083	0	14,083
Cost Burden (Dollars)	211,245	0	211,245

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Abstract: VA Form 21-0538 is used to gather information from veterans about the status of dependents for whom additional compensation is being paid. Without this collection of information, VA would be unable to determine continued eligibility for an additional allowance for dependents.

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Authorizing Statute(s): US Code: 38 USC 501 Name of Law: Veteran's benefits
  

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:
	82 FR 7917	01/23/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 20687	05/03/2017
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Status of Dependents Questionnaire	21-0538	STATUS OF DEPENDENTS QUESTIONNAIRE

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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: $6,222,087

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:  Yes

Description/Changes for Common Form Usage:  VA Form 21-0538 is being revised to include the following substantive changes: • New standardization data points; to include identification information, • New question clarifying the child’s relationship status, and • Change of title from ‘Status of Dependents Questionnaire’ to Mandatory Status of Dependents. A non-substantive change has been added to the letter portion of the form.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 05/31/2017

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