OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Supplement to VA Forms 21-526, 21P-534, and 21P-535 (For Philippine Claims) ( VA Form 21-4169)

ICR 201404-2900-017 · OMB 2900-0094 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21-4169 Supplement to VA Forms 21-526, 21P-534, and 21P-535 (For Philippine Claims) Form Modified Available
2900-0094SuppStmt.docx Supporting Statement A Uploaded 2014-08-05 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28260 Supplement to VA Forms 21-526, 21P-534, and 21P-535 (For Philippine Claims) Form Modified
ICR Details
2900-0094 201404-2900-017
Historical Active 201104-2900-022
VA 2900-0094 VBA-COMP-NK
Supplement to VA Forms 21-526, 21P-534, and 21P-535 (For Philippine Claims) ( VA Form 21-4169)
Revision of a currently approved collection   No
Regular
Approved without change 11/24/2014
Retrieve Notice of Action (NOA) 09/25/2014
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved 01/31/2015
1,000 0 1,000
250 0 250
0 0 0
VA Form 21-4169 is used to gather information that is necessary to determine eligibility for benefits based on service in the Commonwealth Army of the Philippines or recognized guerrilla organizations, including service information, proof of service, place of residence, and membership in pro-Japanese, pro-German, or anti-American Filipino organizations. Without this information, VA would be unable to properly authorize benefits.
US Code: 38 USC 6104 Name of Law: Forfeiture for treason
   US Code: 38 USC 101 Name of Law: Definitions
  
None
Not associated with rulemaking
  79 FR 113 06/12/2014
79 FR 172 09/05/2014
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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 250 250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$41,095
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [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.
09/25/2014