Exam for Housebound Status or Permanent Need for Regular Aid and Attendance

ICR 200804-2900-022 · OMB 2900-0721 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0721 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form VA Form 21-2680 Exam for Housebound Status or Permanent Need for Regular Aid and Attendance	Form	New	Repair queued
21-2680 Justification.doc	Supporting Statement A	Uploaded 2008-10-03	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
185651	Exam for Housebound Status or Permanent Need for Regular Aid and Attendance	Form	New

ICR Details

OMB Control No: 2900-0721	ICR Reference No: 200804-2900-022
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Exam for Housebound Status or Permanent Need for Regular Aid and Attendance
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/03/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved
Responses	14,000	0	0
Time Burden (Hours)	7,000	0	0
Cost Burden (Dollars)	0	0	0

Abstract: This form will be used to gather medical information on behalf of beneficiaries or claimants who are requesting the aid and attendance or housebound benefit and who receive treatment from private doctors or physicians.

Authorizing Statute(s): US Code: 38 USC 1521(d) Name of Law: Veterans of a period of war
   US Code: 38 USC 1521(e) Name of Law: Veterans of a period of war
   US Code: 38 USC 1114 Name of Law: Rates of wartime disability compensation
   US Code: 38 USC 1115(1)(e) Name of Law: Additional compensation for dependents
   US Code: 38 USC 1311(d) Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1541(d) Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1541(e) Name of Law: Surviving spouses of veterans of a period of war

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 142	07/23/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 193	10/03/2008
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Exam for Housebound Status or Permanent Need for Regular Aid and Attendance	VA Form 21-2680	Exam for Housebound Status Or Permanent Need For Regular Aid and Attendance

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	14,000	14,000
Annual Time Burden (Hours)	7,000	7,000
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is new information collection.

Annual Cost to Federal Government: $597,944

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Denise McLamb 202-565-8374 [email protected]

Common Form ICR: No