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Information Collection Request

ANNUAL INCOME QUESTIONNAIRE FOR PENSION AND INSTRUCTIONS FOR COMPLETION

ICR 198107-2900-053 · OMB 2900-0135 · Historical Active

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IC IDCollectionTypeStatusForm
174342 ANNUAL INCOME QUESTIONNAIRE FOR PENSION AND INSTRUCTIONS FOR COMPLETION Form Migrated
ICR Details
2900-0135 198107-2900-053
Historical Active 198011-2900-052
VA
ANNUAL INCOME QUESTIONNAIRE FOR PENSION AND INSTRUCTIONS FOR COMPLETION
No material or nonsubstantive change to a currently approved collection   No
Emergency 07/17/1981
Approved with change 07/17/1981
Retrieve Notice of Action (NOA) 07/17/1981
  Inventory as of this Action Requested Previously Approved
07/31/1984 07/31/1984 06/30/1985
910,000 0 910,000
303,333 0 303,333
0 0 0
THIS FORM IS USED TO FILE THE CLAMANT'S ANNUAL INCOME REPORT. THE INCOME AND DEPENDENCY INFORMATION FURNISHED IS USED TO DETERMINE IF THE CLAMANT IS WITHIN EXISTING INCOME LIMITATIONS AND IF ANY ADJUSTMENT IS DUE IN THE MONTHLY PAYMENT. AUTHORITY IS 38 U.S.C. 506.
None
None
No
1
IC Title Form No. Form Name
ANNUAL INCOME QUESTIONNAIRE FOR PENSION AND INSTRUCTIONS FOR COMPLETION 21-6875 &, 21-6875A
  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 910,000 910,000 0 0 0 0
Annual Time Burden (Hours) 303,333 303,333 0 0 0 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.
07/17/1981