OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201009-2900-016 · OMB 2900-0116 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21-4193 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution Form Modified Repair queued
2900-0116 justification.docx Supporting Statement A Uploaded 2010-12-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
28320 Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution Form Modified
ICR Details
2900-0116 201009-2900-016
Historical Active 200709-2900-021
VA 2900-0116
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 04/08/2011
Retrieve Notice of Action (NOA) 01/03/2011
  Inventory as of this Action Requested Previously Approved
04/30/2014 36 Months From Approved 04/30/2011
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.
US Code: 38 USC 5313 Name of Law: Limitation on payment of compensation and dependency and indemnity compensation to persons incarcera
   US Code: 38 USC 1505 Name of Law: Payment of pension during confinement in penal institutions
  
None
Not associated with rulemaking
  75 FR 191 10/04/2010
75 FR 241 12/16/2010
No
  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
$61,409
No
No
No
No
No
Uncollected
Denise McLamb 202-565-8374 [email protected]
  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.
01/03/2011