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Federal forms, ICRs, and supporting documents

Information Collection Request

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution

ICR 200505-2900-006 · OMB 2900-0116 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28320 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution Form Migrated
ICR Details
2900-0116 200505-2900-006
Historical Active 200203-2900-011
VA
Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution
Extension without change of a currently approved collection   No
Regular
Approved without change 07/08/2005
Retrieve Notice of Action (NOA) 05/11/2005
  Inventory as of this Action Requested Previously Approved
07/31/2008 07/31/2008 07/31/2005
1,664 0 1,664
416 0 416
0 0 0
VA Form 21-4193 is used to gather information from penal institutions about incarcerated VA beneficiaries. When beneficiaries are incarcerated in penal institutions in excess of 60 days after conviction, VA benefits are reduced or terminated. Without this collection of information, VA would be unable to accurately adjust the rates of incarcerated beneficiaries and overpayments would result.
None
None
No
1
IC Title Form No. Form Name
Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution 21-4193
  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 1,664 1,664 0 0 0 0
Annual Time Burden (Hours) 416 416 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.
05/11/2005