OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Exam for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)

ICR 201408-2900-011 · OMB 2900-0721 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 21-2680 Exam for Housebound Status or Permanent Need for Regular Aid and Attendance Form Modified Repair queued
30-Day FRN - 2900-0721 (2015).pdf Supplementary Document Uploaded 2015-01-16 Available
2900-0721 VAF 21-2680 Exam for Household Status.docx Supporting Statement A Uploaded 2015-04-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
185651 Exam for Housebound Status or Permanent Need for Regular Aid and Attendance Form Modified
ICR Details
2900-0721 201408-2900-011
Historical Active 201107-2900-023
VA 2900-0721 VBA-COMP-YM
Exam for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)
Revision of a currently approved collection   No
Regular
Approved without change 05/08/2015
Retrieve Notice of Action (NOA) 01/27/2015
  Inventory as of this Action Requested Previously Approved
05/31/2018 36 Months From Approved 05/31/2015
14,000 0 14,000
7,000 0 7,000
0 0 0
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.
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
  
None
Not associated with rulemaking
  79 FR 59561 10/02/2014
80 FR 2184 01/15/2015
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 14,000 14,000 0 0 0 0
Annual Time Burden (Hours) 7,000 7,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$642,600
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.
01/27/2015