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Federal forms, ICRs, and supporting documents

Information Collection Request

Certificate of Balance on Deposit and Authorization to Disclose Financial Records

ICR 200401-2900-005 · 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
42210 Certificate of Balance on Deposit and Authorization to Disclose Financial Records Form Migrated
ICR Details
2900-0466 200401-2900-005
Historical Active 200007-2900-004
VA
Certificate of Balance on Deposit and Authorization to Disclose Financial Records
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/12/2004
Retrieve Notice of Action (NOA) 01/12/2004
  Inventory as of this Action Requested Previously Approved
01/31/2004 01/31/2004 03/31/2004
23,700 0 23,700
1,185 0 1,185
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 23,700 0 0 0 0
Annual Time Burden (Hours) 1,185 1,185 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.
01/12/2004