OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201712-2900-007 · OMB 2900-0721 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance Form Modified Available
White Paper - No Changes to Form (VAF21-2680).docx Supplementary Document Uploaded 2018-06-21 Available
2900-0721 Summary and Response to Comments (9.21.18) (003).docx Supplementary Document Uploaded 2018-09-21 Repair queued
2900-0721 Supporting Statement (9.24.18).docx Supporting Statement A Uploaded 2018-09-24 Available
30-day FRN, (2900-0721).pdf Supplementary Document Uploaded 2018-06-21 Available
60-day FRN, (2900-0721).pdf Supplementary Document Uploaded 2018-06-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
185651 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance Form Modified
ICR Details
2900-0721 201712-2900-007
Active 201408-2900-011
VA VBA-COMP-DJ/YA
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)
Reinstatement with change of a previously approved collection   No
Regular
Approved with change 09/25/2018
Retrieve Notice of Action (NOA) 06/26/2018
  Inventory as of this Action Requested Previously Approved
09/30/2021 36 Months From Approved
14,000 0 0
7,000 0 0
0 0 0
VA Form 21-2680 is used to determine eligibility for the aid and attendance and/or housebound benefit. VA Form 21-2680 is being revised to include: • New standardization data points; to include optical character recognition information. This is a non-substantive change. • New data question added; defining which benefit the respondent is applying for. This question does not increase the burden.
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
   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
  
None
Not associated with rulemaking
  82 FR 18537 04/19/2017
82 FR 57653 12/06/2017
Yes
  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 0 0 0 0 14,000
Annual Time Burden (Hours) 7,000 0 0 0 0 7,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$806,796
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.
06/26/2018