REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)

ICR 201404-2900-019 · OMB 2900-0405 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0405 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form 21-8941 REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)	Form	Modified	Available
30-Day FRN (2900-0405).pdf	Supplementary Document	Uploaded 2014-09-16	Repair queued
60-Day FRN (2900-0405).pdf	Supplementary Document	Uploaded 2014-08-27	Available
OMB2900-0405(21-8941)(8-27-14).docx	Supporting Statement A	Uploaded 2014-08-27	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
28620	REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)	Form	Modified

ICR Details

OMB Control No: 2900-0405	ICR Reference No: 201404-2900-019
Status: Historical Active	Previous ICR Reference No: 201104-2900-026
Agency/Subagency: VA	Agency Tracking No: 2900-0405 VBA-COMP-DB
Title: REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/03/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/25/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	01/31/2015
Responses	1,200	0	1,200
Time Burden (Hours)	300	0	300
Cost Burden (Dollars)	0	0	0

Abstract: VA Form 21-8941 is used to gather information that is necessary to determine a REPS beneficiary's continued entitlement to REPS benefits. Without this information, VA would be unable to properly authorize benefits, and overpayments would result.

Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Claims and Forms

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:
	79 FR 113	06/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 170	09/03/2014
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
REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377) (21-8941)	21-8941	REPS Annual Eligibility Report (Under the Provisions of Section 156, Public Law 97-377)

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	1,200	1,200
Annual Time Burden (Hours)	300	300
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $26,460

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Crystal Rennie 202 632-7492 [email protected]

Common Form ICR: No