Application for Veterans Pension (VA Form 21P-527EZ) and (VA Form 21P-527)

Forms and Documents

Document Name	Status
Form 21P-527 Application for Veterans Pension (VA Form 21P-527EZ),and (VA Form 21P-527) Form	Modified
30-Day FRN Draft (OMB 2900-0002).docx Supplementary Document	2022-06-13
60 Day FRN (2900-0002).pdf Supplementary Document	2022-03-30
2900-0002, Supporting Statement (VA Forms 21P-527EZ, 21P-527).docx Supporting Statement A	2022-04-20

IC Document Collections

IC ID	Document Title	Status
28067	Application for Veterans Pension (VA Form 21P-527EZ),and (VA Form 21P-527) Form	Modified

ICR Details

OMB Control No: 2900-0002	ICR Reference No: 202203-2900-018
Status: Received in OIRA	Previous ICR Reference No: 202005-2900-015
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Application for Veterans Pension (VA Form 21P-527EZ) and (VA Form 21P-527)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/14/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2023
Responses	53,958	100,000
Time Burden (Hours)	24,731	56,250
Cost Burden (Dollars)	0	0

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Abstract: VA Form 21P-527EZ, is the prescribed form for claiming Veterans Pension under the Fully Developed Claim program. VA Form 21P-527 is used to gather the necessary information to determine a veteran’s eligibility for Veterans Pension. Without this information, VA will not be able to determine a Veteran’s eligibility to the benefit. A Veteran may also use this form to file a new Veterans Pension claim after VA has discontinued a previous pension award and the Veteran is requesting his or her benefits be reinstated.

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Authorizing Statute(s): US Code: 38 USC 1503 Name of Law: Determinations with respect to annual income
   US Code: 38 USC 1502 Name of Law: Determinations with respect to disability
   US Code: 38 USC 5101(a) 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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18484	03/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 35852	06/13/2022
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
Application for Veterans Pension (VA Form 21P-527EZ),and (VA Form 21P-527)	21P-527EZ, 21P-527	Income, Net Worth and Employment Statement ,   Application for Veterans Pension

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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	53,958	100,000	0	-46,042	0	0
Annual Time Burden (Hours)	24,731	56,250	0	-31,519	0	0
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: Burden decreased based on expected decrease in respondents.

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Annual Cost to Federal Government: $2,524,649

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: 06/14/2022

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