OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet (VA Form 21-0773)

ICR 201704-2900-003 · OMB 2900-0720 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 21-0773 Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet Form Modified Available
30-Day FRN - 2900-0720 (2017).pdf Supplementary Document Uploaded 2017-09-12 Available
2900-0720, Supporting Statement (21-0773).docx Supporting Statement A Uploaded 2017-08-03 Available
60-day FRN published on 04-26-17.pdf Supplementary Document Uploaded 2017-04-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
184617 Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet Form Modified
ICR Details
2900-0720 201704-2900-003
Historical Active 201406-2900-013
VA VBA-COMP-YA
Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet (VA Form 21-0773)
Extension without change of a currently approved collection   No
Regular
Approved without change 11/14/2017
Retrieve Notice of Action (NOA) 09/20/2017
  Inventory as of this Action Requested Previously Approved
11/30/2020 36 Months From Approved 03/31/2018
14,000 0 14,000
7,000 0 7,000
0 0 0
The VA Form 21-0773 will serve as a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness.
US Code: 5 USC 552a Name of Law: Records maintained on individuals
  
None
Not associated with rulemaking
  82 FR 19312 04/26/2017
82 FR 37167 08/08/2017
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
$766,806
No
    Yes
    Yes
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 [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.
09/20/2017