Mandatory Verification of Dependents (VA Form 21-0538)

Forms and Documents

Document Name	Status
Form 21-0538 Mandatory Verification of Dependents (VA Form 21-0538) Form	Modified
Emergency Justification (2900-0500).docx Supplementary Document	2020-09-01
2900-0500, Supp Stmt (VAF 21-0538).docx Supporting Statement A	2020-09-01

IC Document Collections

IC ID	Document Title	Status
28684	Mandatory Verification of Dependents (VA Form 21-0538) Form	Modified

ICR Details

OMB Control No: 2900-0500	ICR Reference No: 202009-2900-001
Status: Active	Previous ICR Reference No: 201709-2900-009
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-MS
Title: Mandatory Verification of Dependents (VA Form 21-0538)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/15/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/09/2020
	Date Received in OIRA: 09/02/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	6 Months From Approved	12/31/2020
Responses	540,000	0	84,500
Time Burden (Hours)	90,000	0	14,083
Cost Burden (Dollars)	1,349,968	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 not be able to determine continued eligibility for an additional allowance for dependents.

Emergency Justfication: (1) Veteran Ability to submit Claims Impacted Due to COVID-19. Local travel restrictions and COVID-19 mandated health & safety precautions may impact Veterans' and claimants' abilities to file forms, documents, and other responses in connection with VA Claims & Appeals. (2) Veterans Benefits Administration (VBA) anticipates a potential increase in the submission of claims during and after the state of emergency for COVID-19. To address the effects of COVID-19 on claims processing for Veterans and claimants and to provide better, faster, and more efficient services, VBA proposes to align our modernization efforts with the way we currently receive certain types of veteran/claimant information. As such, VBA has identified the need to revise VA Form 21-0538, Mandatory Verification of Dependents, so we may minimize the potential overpayments that result from the receipt of this form, which could lead to extraneous hardships on our Veterans and claimants. The revision of this form supports the existing automation process, by providing faster and more efficient delivery of service to Veterans and claimants in response to the anticipated increase in claims related submissions that were affected by the COVID-19 pandemic. (3) The revision will also enable VBA to process Veteran data faster due to the use of computerized Optical Character Recognition (OCR) which is the automated process to "read" forms for information upload into VBA systems.

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Authorizing Statute(s): US Code: 38 USC 501 Name of Law: Rules and Regulations
  

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

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
Mandatory Verification of Dependents (VA Form 21-0538)	21-0538	Mandatory Verification of Dependents

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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	540,000	84,500	0	455,500	0	0
Annual Time Burden (Hours)	90,000	14,083	0	75,917	0	0
Annual Cost Burden (Dollars)	1,349,968	211,245	0	1,138,723	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: No

Burden Reduction Due to:

Short Statement: Number of respondents has increased due to the amount of forms sent to veterans through batch process to help cut possible overpayments that may occur.

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Annual Cost to Federal Government: $12,014,730

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? Yes

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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: 09/02/2020

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