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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Accrued Amouts of Veterans Benefits Payable to Surviving Spouse, Child or Dependent Parents

ICR 200208-2900-010 · OMB 2900-0006 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28081 Application for Accrued Amouts of Veterans Benefits Payable to Surviving Spouse, Child or Dependent Parents Form Migrated
ICR Details
2900-0006 200208-2900-010
Historical Active 199912-2900-004
VA
Application for Accrued Amouts of Veterans Benefits Payable to Surviving Spouse, Child or Dependent Parents
Extension without change of a currently approved collection   No
Regular
Approved without change 09/27/2002
Retrieve Notice of Action (NOA) 08/16/2002
  Inventory as of this Action Requested Previously Approved
09/30/2005 09/30/2005 02/28/2003
2,400 0 2,400
1,200 0 1,200
0 0 0
VA Form 21-614 is used by dependents of deceased veterans for the sole purpose of making a claim for accrued benefits available at the time of the veteran's death.
None
None
No
1
IC Title Form No. Form Name
Application for Accrued Amouts of Veterans Benefits Payable to Surviving Spouse, Child or Dependent Parents 21-614
  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 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 1,200 1,200 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.
08/16/2002