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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Accrued Benefits by Veteran's Surviving Spouse, Child, or Dependent Parent

ICR 200204-2900-003 · 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
28123 Application for Accrued Benefits by Veteran's Surviving Spouse, Child, or Dependent Parent Form Migrated
ICR Details
2900-0027 200204-2900-003
Historical Active 199904-2900-007
VA
Application for Accrued Benefits by Veteran's Surviving Spouse, Child, or Dependent Parent
Extension without change of a currently approved collection   No
Regular
Approved with change 06/21/2002
Retrieve Notice of Action (NOA) 04/26/2002
Approved with form changes as discussed with OMB. Contingent upon submission of revised form to OMB within 30 days of approval .
  Inventory as of this Action Requested Previously Approved
06/30/2005 06/30/2005 06/30/2002
100 0 100
33 0 33
0 0 0
This form is used to gather the necessary information from a claimant to determine a claimant's entitlement to accrued benefits withheld during a veteran's hospitalization or domiciliary care.
None
None
No
1
IC Title Form No. Form Name
Application for Accrued Benefits by Veteran's Surviving Spouse, Child, or Dependent Parent 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 100 100 0 0 0 0
Annual Time Burden (Hours) 33 33 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.
04/26/2002