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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Exclusion of Children's Income (VA Form 21P-0571)

ICR 202103-2900-004 · OMB 2900-0510 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21P-0571 Application for Exclusion of Children's Income (21P-0571) Form Modified Repair queued
2021-10113.pdf Supplementary Document Uploaded 2021-05-13 Repair queued
SupportingState(2900-0510).docx Supporting Statement A Uploaded 2021-03-10 Repair queued
2021-04970.pdf Supplementary Document Uploaded 2021-03-10 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
28698 Application for Exclusion of Children's Income (21P-0571) Form Modified
ICR Details
2900-0510 202103-2900-004
Received in OIRA 201708-2900-004
VA VBA-P&F-NK
Application for Exclusion of Children's Income (VA Form 21P-0571)
Reinstatement with change of a previously approved collection   No
Regular 05/13/2021
  Requested Previously Approved
36 Months From Approved
2,700 0
2,025 0
0 0
VBA administers Pension Benefits, which is a needs-based benefit program for wartime Veterans, who are aged 65 or older or have a permanent and total non-service-connected disability and limited income and net worth. Eligibility is determined based on the income of and asset amounts for the Veteran and their spouse. A Veteran’s or surviving spouses’ rate of Improved Pension is determined by family income. Normally, the income of children who are members of the household is included in this determination. However, children’s income may be excluded if it is unavailable or if consideration of that income would cause hardship. 38 U.S.C 1521(h) and 1541(g) provide the authority for the exclusion of children’s income based on unavailability or hardship. VA Form 21P – 0571, Application for Exclusion of Children’s Income, is used for the sole purpose of collecting the information needed to determine if the children’s income is available to the beneficiary, and if it would cause a hardship to consider their income.
US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1521 Name of Law: Veterans of a period of war
  
None
Not associated with rulemaking
  86 FR 4970 03/10/2021
86 FR 10113 05/13/2021
No
1
IC Title Form No. Form Name
Application for Exclusion of Children's Income (21P-0571) VA Form 21P-0571 Application for Exclusion of Children's Income
  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 2,700 0 0 0 0 2,700
Annual Time Burden (Hours) 2,025 0 0 0 0 2,025
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$120,721
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.
05/13/2021