Dependents' Application for VA Education Benefits (Under Provisions of Chapter 33 and 35, Title 38, U.S.C.) (VA Form 22-5490)

Forms and Documents

Document Name	Status
Form 22-5490 Dependents' Application for VA Education Benefits Form	Modified
30-Day FRN - 2900-0098 (2021).pdf Supplementary Document	2021-12-17
60 Day Actual FRN.pdf Supplementary Document	2021-10-14
SUPPORTING STATEMENT 2021 w 60day Citation 10-14-2021.docx Supporting Statement A	2021-10-14

IC Document Collections

IC ID	Document Title	Status
28269	Dependents' Application for VA Education Benefits Form	Modified

ICR Details

OMB Control No: 2900-0098	ICR Reference No: 202109-2900-010
Status: Received in OIRA	Previous ICR Reference No: 202007-2900-016
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-YA
Title: Dependents' Application for VA Education Benefits (Under Provisions of Chapter 33 and 35, Title 38, U.S.C.) (VA Form 22-5490)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/17/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	63,807	0
Time Burden (Hours)	47,855	0
Cost Burden (Dollars)	0	0

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Abstract: Spouses, surviving spouses, and children of veterans or servicemembers must submit evidence to establish basic eligibility for and entitlement to Survivors' and Dependents' Educational Assistance (DEA) under chapter 35, title 38, U. S. C. VA Form 22-5490 serves as the procedural requirement for these applicants to apply to the Department of Veterans Affairs (VA) for DEA benefits. VA claims examiners use the information from this collection to help determine whether an applying individual qualifies for DEA or Fry Scholarship benefits. The information will also be used to determine if the program of education the applicant wishes to pursue is approved for educational assistance. The information on the form can be obtained only from the claimant, and a determination cannot be made without the information.

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Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Claims and forms
   US Code: 38 USC 5102 Name of Law: Application forms furnished upon request; notice to claimants of incomplete applications
   PL: Pub.L. 113 - 146 701-702 Name of Law: Veterans Access, Choice, and Accountability Act of 2014
   US Code: 38 USC 5103 Name of Law: Notice to claimants of required information and evidence
   US Code: 38 USC 5113 Name of Law: Effective dates of educational benefits
   US Code: 38 USC 3513 Name of Law: Veterans' Benefits (dependent application)
  

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:
	86 FR 57000	10/13/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 71706	12/17/2021
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
Dependents' Application for VA Education Benefits	22-5490	Dependents' Application for VA Education Benefits

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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	63,807	0	0	12,826	0	50,981
Annual Time Burden (Hours)	47,855	0	0	18,115	0	29,740
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: The renewal for this information collection results in a slight increase in burden hours for the periods 2018, 2019 and 2021 due to a decrease in the number of applications received.

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Annual Cost to Federal Government: $167,226

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

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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: 12/17/2021

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