Application for Reimbursement of Headstone or Marker Expense (VA Form 21P-8834)

Forms and Documents

Document Name	Status
Form VA Form 21P-8834 APPLICATION FOR REIMBURSEMENT OF HEADSTONE OR MARKER EXPENSES Form	Modified
2900-0266 Supporting Statement (21P-8834) (reinstatement).docx Supporting Statement A	2024-08-26
2024-18896.pdf Supplementary Document	2024-08-26
2024-13375.pdf Supplementary Document	2024-06-20

IC Document Collections

IC ID	Document Title	Status
147844	APPLICATION FOR REIMBURSEMENT OF HEADSTONE OR MARKER EXPENSES Form	Modified

ICR Details

OMB Control No: 2900-0266	ICR Reference No: 202406-2900-003
Status: Received in OIRA	Previous ICR Reference No: 199304-2900-001
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Application for Reimbursement of Headstone or Marker Expense (VA Form 21P-8834)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/26/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/1996
Responses	1,000	40,000
Time Burden (Hours)	167	6,700
Cost Burden (Dollars)	0	0

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Abstract: VA Form 21P-8834 is used by any person who purchased and paid for a headstone, marker or additional engraving on behalf of a deceased Veteran or Service Person.

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Authorizing Statute(s): US Code: 38 USC 2306 Name of Law: Headstones, markers, and burial receptacles
  

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:
	89 FR 51596	06/18/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 68242	08/23/2024
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 REIMBURSEMENT OF HEADSTONE OR MARKER EXPENSES	VA Form 21P-8834	Application for Reimbursement of Headstone or Marker Expenses

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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	1,000	40,000	0	-39,000	0	0
Annual Time Burden (Hours)	167	6,700	0	-6,533	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: The burden decrease is due to a decrease in the number of receivables averaged over the past year.

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Annual Cost to Federal Government: $13,045

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: 08/26/2024

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