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Federal forms, ICRs, and supporting documents

Information Collection Request

APPLICATION ON THE DEATH OF VETERAN BY THE IMMEDIATE FAMILY FOR ACCRUED BENEFITS WITHELD DURING TREATMENT OR CARE

ICR 197208-2900-001 · OMB 2900-0027 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
146598 APPLICATION ON THE DEATH OF VETERAN BY THE IMMEDIATE FAMILY FOR ACCRUED BENEFITS WITHELD DURING TREATMENT OR CARE Form Migrated
ICR Details
2900-0027 197208-2900-001
Historical Active
VA
APPLICATION ON THE DEATH OF VETERAN BY THE IMMEDIATE FAMILY FOR ACCRUED BENEFITS WITHELD DURING TREATMENT OR CARE
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/02/1972
Retrieve Notice of Action (NOA) 08/02/1972
  Inventory as of this Action Requested Previously Approved
08/31/1979 08/31/1979
3,000 0 0
1,000 0 0
0 0 0

None
None
No
1
IC Title Form No. Form Name
APPLICATION ON THE DEATH OF VETERAN BY THE IMMEDIATE FAMILY FOR ACCRUED BENEFITS WITHELD DURING TREATMENT OR CARE 21-551
  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 3,000 0 0 0 3,000 0
Annual Time Burden (Hours) 1,000 0 0 0 1,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/02/1972