OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)

ICR 201903-2900-011 · OMB 2900-0572 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21-0304 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities Form Modified Repair queued
2019-11583.pdf Supplementary Document Uploaded 2019-06-04 Available
2019-04721, 60-Day FRN (VAF21-0304).pdf Supplementary Document Uploaded 2019-03-20 Available
2900-0572, Supporting Statement (VAF 21-0304).docx Supporting Statement A Uploaded 2019-11-27 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28777 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities Form Modified
ICR Details
2900-0572 201903-2900-011
Active 201508-2900-009
VA VBA-COMP-NK
Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 02/14/2020
Retrieve Notice of Action (NOA) 11/27/2019
In its next revision or extension request, VA will modify the Privacy Act statement from "Your obligation to respond is required in order to obtain or retain benefits" to "Your response is required in order to obtain or retain benefits."
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved
430 0 0
72 0 0
0 0 0
VA Form 21-0304 is used to gather information necessary to determine eligibility for a monetary allowance for a child born with spina bifida or certain birth defects who is a natural child of a Vietnam or certain Korea service veteran.
US Code: 38 USC Section 1805 Name of Law: Monetary allowance
   US Code: 38 USC Section 1815 Name of Law: Monetary allowance
  
None
Not associated with rulemaking
  84 FR 9413 03/14/2019
84 FR 11583 06/04/2019
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 430 0 0 0 0 430
Annual Time Burden (Hours) 72 0 0 0 0 72
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$13,393
No
    Yes
    Yes
No
No
No
Uncollected
Danny Green 202 421-1354 [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.
11/27/2019