OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Veteran's Application for Increased Compensation Based on Unemployability

ICR 201103-2900-004 · OMB 2900-0404 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 21-8940 Veteran's Application for Increased Compensation Based on Unemployability Form Modified Repair queued
2900-0404 justification.docx Supporting Statement A Uploaded 2011-06-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
28617 Veteran's Application for Increased Compensation Based on Unemployability Form Modified
ICR Details
2900-0404 201103-2900-004
Historical Active 200709-2900-012
VA 2900-0404
Veteran's Application for Increased Compensation Based on Unemployability
Extension without change of a currently approved collection   No
Regular
Approved without change 09/05/2011
Retrieve Notice of Action (NOA) 06/28/2011
  Inventory as of this Action Requested Previously Approved
09/30/2014 36 Months From Approved 09/30/2011
24,000 0 24,000
18,000 0 18,000
0 0 0
VA Form 21-8940 is used to gather information that is necessary to determine eligibility for increased compensation based on unemployability.
US Code: 38 USC 1163 Name of Law: Trial work periods and vocational rehabilitation for certain veterans with total disability ratings.
  
None
Not associated with rulemaking
  76 FR 53 03/18/2011
76 FR 109 06/07/2011
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 24,000 24,000 0 0 0 0
Annual Time Burden (Hours) 18,000 18,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$3,202,840
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.
06/28/2011