In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.
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36 Months From Approved
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VA Form 21P-0969 will be used by claimants for VA pension or Parents' Dependency and Indemnity Compensation (DIC) to provide information pertaining to income and assets to establish entitlement to pension or Parents' DIC. This form will be completed only by those claimants who had income other than Social Security benefits during the calendar year before claiming benefits or who disposed of assets or have significant assets.
US Code:
38 USC 1503
Name of Law: Determinations with respect to annual income
US Code:
38 USC 1541
Name of Law: Surviving spouses of veterans of a period of war
US Code:
38 USC 1543
Name of Law: Net worth limitation
US Code:
38 USC 1315
Name of Law: Dependency and indemnity compensation to parents
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.
Form VA Form 21P-0969 Income and Asset Statement in Support of Claim for
JS - 21P-0969 (New CR 12 30 14) 12.30.14.doc
Income and Asset Statement in Support of Claim for