Request for Substitution of Claimant upon Death of Claimant (VA Form 21P-0847)

ICR 202108-2900-010 · OMB 2900-0740 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0740 can be found here:

2024-10-18 - Revision of a currently approved collection

Forms and Documents

Document	Type	Status	Availability
Form 21P-0847 Request for Substitution of Claimant upon Death of Claimant (VA Form 21P-0847)	Form	Modified	Missing upstream
30-Day FRN - 2900-0740 (2021) 10-29-21.pdf	Supplementary Document	Uploaded 2021-10-29	Repair queued
2021-17622, 60-Day FRN (VA Form 21P-0847).pdf	Supplementary Document	Uploaded 2021-08-18	Repair queued
2900-0740, Supporting Statement (VA Form 21P-0847)..docx	Supporting Statement A	Uploaded 2021-08-18	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
189428	Request for Substitution of Claimant upon Death of Claimant (VA Form 21P-0847)	Form	Modified

ICR Details

OMB Control No: 2900-0740	ICR Reference No: 202108-2900-010
Status: Received in OIRA	Previous ICR Reference No: 201806-2900-004
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Request for Substitution of Claimant upon Death of Claimant (VA Form 21P-0847)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2021
Responses	20,000	20,000
Time Burden (Hours)	1,667	1,667
Cost Burden (Dollars)	0	0

Abstract: VA Form 21P-0847 is used to allow claimants to request substitution for a claimant, who passed away, prior to VA processing a claim to completion. This is only allowed when a claimant dies while a claim or appeal for any benefit under a law administered by the VA is pending. The substitute claimant would be eligible to receive accrued benefits due a deceased claimant under Section 5121(a).

Authorizing Statute(s): US Code: 38 USC 5121A Name of Law: Payment of certain accrued benefits upon death of a beneficiary

Citations for New Statutory Requirements: None

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

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 46095	08/17/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 60110	10/29/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Request for Substitution of Claimant upon Death of Claimant (VA Form 21P-0847)	21P-0847	Request for Substitution of Claimant upon Death of Claimant

ICR Summary of Burden

	Total Request	Previously Approved
Annual Number of Responses	20,000	20,000
Annual Time Burden (Hours)	1,667	1,667
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $995,135

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? No

Agency Contact: Maribel Aponte 202 266-4688 [email protected]

Common Form ICR: No