OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819)

ICR 201803-2900-003 · OMB 2900-0704 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 21-0819 DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819) Form Modified Available
30-Day FRN - 2900-0704 (2018).pdf Supplementary Document Uploaded 2018-03-27 Repair queued
2018-00233, 60-Day FRN (2900-0704).pdf Supplementary Document Uploaded 2018-03-14 Repair queued
2900-0704 Supporting Stmt (VAF 21-0819) Final.docx Supporting Statement A Uploaded 2018-07-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
181456 DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819) Form Modified
ICR Details
2900-0704 201803-2900-003
Active 201508-2900-010
VA VBA-COMP-YA
DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819)
Revision of a currently approved collection   No
Regular
Approved with change 07/06/2018
Retrieve Notice of Action (NOA) 04/18/2018
  Inventory as of this Action Requested Previously Approved
07/31/2021 36 Months From Approved 07/31/2019
14,000 0 14,000
3,500 0 7,000
0 0 0
This form is used in a joint effort between VA and the Department of Defense (DoD), as recommended by former President Bush’s Interagency Task Force on Returning Global War on Terror Heroes, to determine an injured or ill Global War on Terrorism (GWOT) service member’s military readiness fitness for military retention, level of disability for retirement, and VA Disability compensation. VA Form 21-0819 has been updated, to include: • A new title. • New standardization data points; to include optical character recognition boxes. This is a non-substantive change. • The burden has been decreased from 30 to 15 minutes.
US Code: 38 USC 5101 Name of Law: Veteran's Benefits
  
None
Not associated with rulemaking
  83 FR 1285 01/10/2018
83 FR 12082 03/19/2018
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 14,000 0 0 0 0
Annual Time Burden (Hours) 3,500 7,000 0 -3,500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
1. The respondent burden has been decreased in half; from 30 to 15 minutes. 2. VA Form 21-0819 has been updated, to include: • A new title. • New standardization data points; to include optical character recognition boxes. However, this change is non-substantive.
$609,963
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.
04/18/2018