Application for DIC, Death Pension, and/or Accrued Benefits; Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child; Application for Dependency and Indemnity Compensation

Forms and Documents

Document Name	Status
Form 21P-534a APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a) Form	Modified
Form 21P-534 APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable) Form and Instruction	New
Form 21P-534EZ APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS Form and Instruction	New
2900-0004 Supporting Statement 20181019.docx Supporting Statement A	2018-10-19

IC Document Collections

IC ID	Document Title	Status
28073	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a) Form	Modified
232907	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable) Form and Instruction	New
232583	APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS Form and Instruction	New

ICR Details

OMB Control No: 2900-0004	ICR Reference No: 201808-2900-005
Status: Active	Previous ICR Reference No: 201801-2900-002
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Application for DIC, Death Pension, and/or Accrued Benefits; Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child; Application for Dependency and Indemnity Compensation
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: 10/19/2018
	Date Received in OIRA: 09/18/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	36 Months From Approved	06/30/2021
Responses	101,426	0	115,000
Time Burden (Hours)	62,857	0	69,091
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Veterans Affairs (VA), through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services, established by law, for veterans, service personnel, and their dependents and/or beneficiaries. Title 38 U.S.C. 5101(a) provides that a specific claim in the form provided by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by the Secretary. VA Forms 21P-534EZ and 21P-534 will be the prescribed forms for applications for Dependency and Indemnity Compensation (DIC), Death Pension, and/or Accrued benefits. VA Form 21P-534a will be the prescribed form for DIC when the Veteran died while in service. Information is requested by these forms under the authority of 38 U.S.C. 1310 through 1314 and 1532 through 1543. In RIN 2900-AO73, VA proposes to amend its pension regulations to maintain the integrity of its needs-based pension program. VA has authority under 38 U.S.C. 501(a) to prescribe all rules and regulations which are necessary or appropriate to carry out the laws administered by VA. VA would amend its information collections in conjunction with RIN 2900-AO73. This rulemaking is largely in response to a Government Accountability Office (GAO) report, GAO-12-50, Veterans’ Pension Benefits: Improvements Needed to Ensure Only Qualified Veterans and Survivors Receive Benefits. VA Form 21P-534EZ is used to gather the necessary information to determine the eligibility of surviving spouses and children for dependency and indemnity compensation (DIC), death pension, accrued benefits, and death compensation. This form is used to by claimants to apply under the Fully Developed Claim program. VA Form 21P-534 is used to gather the necessary information to determine the eligibility of surviving spouses and children for dependency and indemnity compensation (DIC), death pension, accrued benefits, and death compensation. This form is used to by claimants to apply under the Fully Developed Claim program. VA Form 21P-534a is an abbreviated application for DIC that is used only by surviving spouses and children of veterans who died while on active duty service.

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Authorizing Statute(s): US Code: 38 USC 1312 Name of Law: Benefits in certain cases of in-service or service-connected deaths
   US Code: 38 USC 1313 Name of Law: Dependency and indemnity compensation to children
   US Code: 38 USC 1532 Name of Law: Surviving spouses of Civil War veterans
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1543 Name of Law: Net worth limitation
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1314 Name of Law: Supplemental dependency and indemnity compensation to children
   US Code: 38 USC 1533 Name of Law: Children of Civil War veterans
   US Code: 38 USC 1534 Name of Law: Surviving spouses of Indian War veterans
   US Code: 38 USC 1535 Name of Law: Children of Indian War veterans
   US Code: 38 USC 1536 Name of Law: Surviving spouses of Spanish-American War veterans
   US Code: 38 USC 1537 Name of Law: Children of Spanish-American War veterans
   US Code: 38 USC 1311 Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1542 Name of Law: Children of veterans of a period of war
   US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 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:
2900-AO73	Final or interim final rulemaking	83 FR 47246	09/18/2018

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	21P-534a	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only
APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS	21P-534EZ	Application for DIC, Survivors Pension, and/or Accrued Benefits
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	21P-534	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)

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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	101,426	115,000	0	-13,574	0	0
Annual Time Burden (Hours)	62,857	69,091	0	-6,234	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The reduction in the number of estimated annual respondents and burden hours was published in the Notice of Proposed Rulemaking 2900-AO73 (80 FR 3839 through 386, on January 23, 2015).

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Annual Cost to Federal Government: $6,673,324

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: 09/18/2018

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