OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Certificate of Balance on Deposit and Authorization to Disclose Financial Records

ICR 200007-2900-004 · OMB 2900-0466 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28664 Certificate of Balance on Deposit and Authorization to Disclose Financial Records Form Migrated
ICR Details
2900-0466 200007-2900-004
Historical Active 199508-2900-039
VA
Certificate of Balance on Deposit and Authorization to Disclose Financial Records
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 10/03/2000
Retrieve Notice of Action (NOA) 07/20/2000
Approved consistent with clarifications in VA memo of 10-2-00. This collection previously expired in September 1998. VA must have a system in place to ensure that such future violations of the Paperwork Reduction Act do not occur. Upon resubmitting this collection VA shall demonstrate the steps it has taken to allow electronic submission of this collection and comply with the Government Paperwork Elimination Act.
  Inventory as of this Action Requested Previously Approved
10/31/2003 10/31/2003
23,700 0 0
1,185 0 0
0 0 0
VA needs the information in order to adequately supervise benefits paid to fiduciaries of incompetent beneficiaries. This form is for completion by financial institutions, upon request from fiduciaries who must include the certification with accountings to be submitted to VA. The information is needed by VA to verify financial information furnished by fiduciary on accountgs. It is a mechanism to assist in the detection of fraud, waste and abuse of beneficiaries' funds.
None
None
No
1
IC Title Form No. Form Name
Certificate of Balance on Deposit and Authorization to Disclose Financial Records 21-4178A
  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 23,700 0 0 23,700 0 0
Annual Time Burden (Hours) 1,185 0 0 1,185 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
07/20/2000