Eligibility Verification Reports (EVRs)

Forms and Documents

Document Name	Status
Form VA Form 21P-0510 Eligibility Verification Reports Form	Modified
2900-0101 30-Day FRN.pdf Supplementary Document	2018-04-02
2900-0101 60-Day FRN.pdf Supplementary Document	2018-01-19
2900-0101 Supporting Statement.docx Supporting Statement A	2018-03-19

IC Document Collections

IC ID	Document Title	Status
28278	Eligibility Verification Reports Form	Modified

ICR Details

OMB Control No: 2900-0101	ICR Reference No: 201708-2900-012
Status: Active	Previous ICR Reference No: 201404-2900-008
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Eligibility Verification Reports (EVRs)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/25/2018
	Date Received in OIRA: 05/01/2018
Terms of Clearance: VA is reminded that labor costs should not be included in the burden cost estimate. In addition, a reduction to the estimated length of time required to fill out a form, without changes that reduce/alter the data elements requested, is not a "deregulatory" action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	69,000	0	219,000
Time Burden (Hours)	34,500	0	113,075
Cost Burden (Dollars)	0	0	2,713,800

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Abstract: The EVR forms are used to determine and verify entitlement to income-based VA benefits. The forms are tailored for the specific classes of beneficiaries of each benefit program and request information about income, net worth, dependency status and other entitlement factors. Without this information, VA would be unable to properly pay benefits.

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Authorizing Statute(s): US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
  

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:
	83 FR 2878	01/19/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 13350	03/28/2018
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
Eligibility Verification Reports	VA Form 21P-0512S-1 (Spanish), VA Form 21P-0513-1 (Spanish), VA Form 21P-0514-1, VA Form 21P-0514-1 (Spanish), VA Form 21P-0517-1, VA Form 21P-0512V-1, VA Form 21P-0513-1, VA Form 21P-0516-1, VA Form 21P-0519C-1 (Spanish), VA Form 21P-0519S-1, VA Form 21P-0510, VA Form 21P-0510 (Spanish), VA Form 21P-0519C-1, VA Form 21P-0519S-1 (Spanish), VA Form 21P-0512S-1, VA Form 21P-0516-1 (Spanish), VA Form 21P-0517-1 (Spanish), VA Form 21P-0518-1, VA Form 21P-0518-1 (Spanish)	Eligibility Verification Report Instructions ,   Eligibility Verification Report Instructions (Spanish) ,   Old Law Section 306 Eligibility Verification Report (Surviving Spouse) ,   Old Law and Section 306 Eligibility Verification Report (Surviving Spouse) ,   Old Law and 306 Eligibility Verification Report (Veteran) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) ,   DIC Eligibility Verification Report ,   DIC Parent's Eligibility Verification Report ,   Improved Pension Eligibility Verification Report (Veteran With No Children) ,   Improved Pension Eligibility Verification Report (Veteran With No Children) ,   Improved Pension Eligibility Verification Report (Veteran With Children) ,   Improved Pension Eligibility Verification Report (Veteran With Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse With No Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse With No Children) ,   Improved Pension Eligibility Verification Report (Child or Children) ,   Improved Pension Eligibility Verification Report (Child or Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse With Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse With Children)

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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	69,000	219,000	0	0	-150,000	0
Annual Time Burden (Hours)	34,500	113,075	0	0	-78,575	0
Annual Cost Burden (Dollars)	0	2,713,800	0	0	-2,713,800	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: VBA conducted a program review to determine the number of forms received in a given year. VBA determined it regularly receives fewer of the forms listed in this collection than previously reported. VBA also conducted a review of the time burden of each form in this collection, and determined the average time burden to be 30 minutes for each form, which is less than the previously reported time burden for some of the forms.

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Annual Cost to Federal Government: $1,800,095

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? 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: 05/01/2018

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