Lay/Witness Statement (VA Form 21-10210)

OMB Control No: 2900-0881	ICR Reference No: 202007-2900-007
Status: Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-CS-MS
Title: Lay/Witness Statement (VA Form 21-10210)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/31/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/27/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	100,000	0	0
Time Burden (Hours)	16,667	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-10210 will be used by the claimant to gather lay or witness statements that support an existing claim for benefits or services. Without this information, VA may not be able to efficiently and successfully process claims that may require additional statements associated with a claim for benefits or services.

Emergency Justfication: (1) Veteran Ability to submit Claims Impacted Due to COVID-19. Local travel restrictions and COVID-19 mandated health & safety precautions may impact Veterans' and claimants' abilities to file forms, documents, and other responses in connection with VA Claims & Appeals. (2) Veterans Benefits Administration (VBA) anticipates a potential increase in the submission of claims during and after the state of emergency for COVID-19. In an effort to address the effects of COVID-19 on claims processing for Veterans and claimants and to provide better, faster, and more efficient services, VBA proposes to align our modernization efforts with the way we currently receive certain types of veteran/claimant information. VBA has identified the need for 3 new forms that will reduce the submission of the current free-text form which does not support our current automation processing. By creating these new forms that do support the existing automation processes we will be able to provide faster and more efficient delivery of service to Veterans and claimants in response to the anticipated increase in claims related submissions that were affected by the COVID-19 pandemic. (3) This new form will also enable VBA to process Veteran data faster due to the use of computerized Optical Character Recognition (OCR) which is the automated process to "read" forms for information upload into VBA systems.

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Authorizing Statute(s): US Code: 38 USC 501 Name of Law: Rules and Regulations    US Code: 38 USC 5103 Name of Law: Due Process    US Code: 38 USC 5101(a) Name of Law: Claims and Forms

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name Lay/Witness Statement (VA Form 21-10210) VA Form 21-10210 Lay/Witness Statement

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ICR Summary of Burden

	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	100,000	0	0	100,000	0	0
Annual Time Burden (Hours)	16,667	0	0	16,667	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection request.

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Annual Cost to Federal Government: $2,224,950

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

Agency Contact: Danny Green 202 421-1354 [email protected]

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Common Form ICR:  No

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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:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(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;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
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.
Certification Date: 07/27/2020

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