Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors) (VA Form 21-8924)

ICR 201408-2900-014 · OMB 2900-0390 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0390 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form VA Form 21-8924 Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)	Form	Modified	Repair queued
30-Day FRN - 2900-0390 (2014).pdf	Supplementary Document	Uploaded 2014-10-03	Available
SuppStmt, 21-8924, (8-28-14).docx	Supporting Statement A	Uploaded 2014-08-28	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
28601	Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)	Form	Modified

ICR Details

OMB Control No: 2900-0390	ICR Reference No: 201408-2900-014
Status: Historical Active	Previous ICR Reference No: 201103-2900-003
Agency/Subagency: VA	Agency Tracking No: 2900-0390 VBA-COMP-DB
Title: Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors) (VA Form 21-8924)
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: 12/23/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/03/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2014
Responses	1,800	0	1,800
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

Abstract: VA Form 21-8924 is used to gather information that is necessary to determine entitlement of a veteran's surviving spouse or child to REPS benefits.

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 33809	06/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 57181	09/24/2014
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
Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)	VA Form 21-8924	Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	1,800	1,800
Annual Time Burden (Hours)	600	600
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: $50,718

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