Court Appointed Fiduciary's Account, Federal Fiduciary's Account, Account Book, Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and Authorization to Disclose Financial Records

Forms and Documents

Document Name	Status
Form 21P-4706c Court Appointed Fiduciary's Account (letter size), VA Fiduciary's Account, and Certificate of Balance on Deposit and.... Form	Modified
30-Day FRN - 2900-0017 (2019).pdf Supplementary Document	2019-09-06
White Paper Explanation of Expiration of Accounting Forms.docx Supplementary Document	2019-08-30
2900_0017 Federal Register 60 d.pdf Supplementary Document	2019-06-18
2900-0017_justification_FINAL_08 29 19.docx Supporting Statement A	2019-08-30

IC Document Collections

IC ID	Document Title	Status
28106	Court Appointed Fiduciary's Account (letter size), VA Fiduciary's Account, and Certificate of Balance on Deposit and.... Form	Modified

ICR Details

OMB Control No: 2900-0017	ICR Reference No: 201905-2900-004
Status: Active	Previous ICR Reference No: 201602-2900-007
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Court Appointed Fiduciary's Account, Federal Fiduciary's Account, Account Book, Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and Authorization to Disclose Financial Records
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2019
	Date Received in OIRA: 09/06/2019
Terms of Clearance: Approval is granted with the following terms of clearance: 1. Fiduciaries shall not be required to retain any records for more than 3 years unless there is a specific and non-discretionary statutory or regulatory requirement for longer retention and shall be notified by VA of their the timeline for retention; and prior to requesting extension or revision of this collection, the Program Office 2a. shall consult with the VA Privacy Office on whether the routine uses listed in the Privacy Act statement satisfy the requirements of 5 USC 552a(e)(3)(C), and 2b. Shall explore the possibility of reducing burden on fiduciaries and financial institutions, including through use of the periodic statements produced under 12 CFR 230.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved
Responses	33,500	0	0
Time Burden (Hours)	11,167	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VA maintains supervision of the distribution and use of VA benefits paid to fiduciaries on behalf of VA beneficiaries who are incompetent, a minor, or under legal disability. The forms are used to verify beneficiaries’ deposit remaining at a financial institution against a fiduciary’s accounting. The following forms will be used to ensure claimants’ benefits payments are administered properly. (a) VA Forms 21P-4706b and 4706c are used by VA to determine proper usage of benefits paid to fiduciaries. The 21P–4706c is provided to assist VA fiduciaries in conforming to requirements of various State courts. (b) VA Form 21P–4718a—Fiduciaries are required to obtain certifications that the balances remaining on deposit in financial institutions as shown on accountings are correct. Certifying official at a financial institution completing the form must affix the institution’s official seal or stamp. The data collected is used to confirm appointment of a fiduciary for a VA beneficiary and to prevent fiduciaries from supplying false certification, embezzling funds, and possibly prevent and/or identify fraud, waste and abuse of government funds paid to fiduciaries on behalf of VA beneficiaries. Without this information, VA would be unable to determine if the veteran's fiduciary is properly using the funds for this benefit according to VA law.

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Authorizing Statute(s): US Code: 38 USC 5502 Name of Law: Payments to and supervision of fiduciaries
   PL: Pub.L. 108 - 454 502-504 Name of Law: Veterans Benefits Improvement Act of 2004
  

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:
	84 FR 28395	06/18/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 47071	09/06/2019
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
Court Appointed Fiduciary's Account (letter size), VA Fiduciary's Account, and Certificate of Balance on Deposit and....	21P4706b, 21P-4706c, 21P-4718a	COURT APPOINTED FIDUCIARY'S ACCOUNT ,   CERTIFICATE OF BALANCE ON DEPOSIT AND AUTHORIZATION TO DISCLOSE FINANCIAL RECORDS  ,   VA FIDUCIARY'S ACCOUNT

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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	33,500	0	0	-1,500	0	35,000
Annual Time Burden (Hours)	11,167	0	0	-500	0	11,667
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Pension and Fiduciary Service changed fiduciary appointment types and therefore the population required to account decreased.

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Annual Cost to Federal Government: $587,471

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.     No

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: 09/06/2019

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