OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Statement in Support of Claim for Service Connection for PTSD (VA Form 21-0781), Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault (VA Form 21-0781a)

ICR 202009-2900-006 · OMB 2900-0659 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 21-0781 Statement in Support of Claim for Service Connection for PTSD (VAF21-0781), Statement in Support of Claim for Service Connection for PTSD(VAF 21-0781a) Form Modified Repair queued
2021-03882, 30-Day FRN (2900-0659).pdf Supplementary Document Uploaded 2021-02-25 Repair queued
2020-24647, 60-Day FRN (2900-0659).pdf Supplementary Document Uploaded 2020-12-17 Repair queued
2900-0659, Supporting Stmt (VAF21-0781 series).docx Supporting Statement A Uploaded 2021-02-19 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28937 Statement in Support of Claim for Service Connection for PTSD (VAF21-0781), Statement in Support of Claim for Service Connection for PTSD(VAF 21-0781a) Form Modified
ICR Details
2900-0659 202009-2900-006
Received in OIRA 201610-2900-003
VA VBA-COMP-MS
Statement in Support of Claim for Service Connection for PTSD (VA Form 21-0781), Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault (VA Form 21-0781a)
Reinstatement with change of a previously approved collection   No
Regular 03/05/2021
  Requested Previously Approved
36 Months From Approved
20,374 0
23,770 0
0 0
VA Forms 21-0781 and 21-0781a are used to gather information about stressful incidents in service from veterans claiming compensation for Post-Traumatic Stress Disorder (PTSD). The forms request the information that is necessary for VA to conduct meaningful research of records in order to assist claimants in obtaining credible supporting evidence that the incidents occurred. Without this collection of information, VA would not be able to fulfill its statutory duty to assist for claimants and would be unable to properly authorize benefits. No changes have been made to these forms. The increase in respondent burden is due to the estimated number of receivables from the previous year.
US Code: 38 USC 5101 Name of Law: Claims and Forms
   US Code: 38 USC 5103a Name of Law: Duty to assist claimants
   US Code: 38 USC 5107a Name of Law: Claimant responsibility; benefit of the doubt
  
None
Not associated with rulemaking
  85 FR 71139 11/06/2020
86 FR 11593 02/25/2021
No
  Total Request 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 20,374 0 0 5,134 0 15,240
Annual Time Burden (Hours) 23,770 0 0 5,990 0 17,780
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The respondent burden has increased due to the estimated number of receivables averaged over the past year.
$1,282,991
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 [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.
03/05/2021