VA Fiduciary's Account(VA Form 21P-4706b),Court Appointed Fiduciary's Account(VA Form 21P-4706c),Cert. of Bal. on Deposit and Auth. to Dis. Financial Record(21P-4718a))

Forms and Documents

Document Name	Status
Form VA Form 21P-4706b VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a) Form	Modified
2021-23492.pdf Supplementary Document	2021-10-28
2021-18195.pdf Supplementary Document	2021-08-24
2900-0017_SS.2021 for (4706b,c 4718a).docx Supporting Statement A	2021-09-01

IC Document Collections

IC ID	Document Title	Status
28106	VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a) Form	Modified

ICR Details

OMB Control No: 2900-0017	ICR Reference No: 202108-2900-003
Status: Received in OIRA	Previous ICR Reference No: 201905-2900-004
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: VA Fiduciary's Account(VA Form 21P-4706b),Court Appointed Fiduciary's Account(VA Form 21P-4706c),Cert. of Bal. on Deposit and Auth. to Dis. Financial Record(21P-4718a))
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/28/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2021
Responses	53,159	33,500
Time Burden (Hours)	17,720	11,167
Cost Burden (Dollars)	0	0

---

Abstract: VA Forms 21P-4706b, 21P-4706c, and 21P-4718a will be completed by VA-appointed fiduciaries of VA beneficiaries. The information will be used by VA fiduciary hub staff to determine whether an individual is an appropriate fiduciary and properly using and maintaining an accounting of the VA beneficiaries compensation or pension payments. VA continues to use the information provided on these forms in the oversight of VA-appointed fiduciaries.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 18195	08/24/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 23492	10/28/2021
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
VA Fiduciary's Account (VA Form 21P-4706b), Court Appointed Fiduciary's Account (VA Form 21P-4706c) Certificate of Bal. on Deposit and Auth. to Disclose Financial Record (VA Form 21P-4718a)	VA Form 21P-4706b, VA Form 21P-4706c, VA Form 21P-4718a	VA Fiduciary's Account ,   Court Appointed Fiduciary's Account ,   Certificate of Balance on Deposit and Authorization to Disclose Financial Records

---

ICR Summary of Burden

	Total Request	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	53,159	33,500	0	19,659	0	0
Annual Time Burden (Hours)	17,720	11,167	0	6,553	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: No

Burden Reduction Due to:

Short Statement: Increase due to an increase in the number of appointed fiduciaries.

---

Annual Cost to Federal Government: $6,130,063

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? No

---

Common Form ICR:  No

---

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: 10/28/2021

---