OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application Request to Add and/or Remove Dependents (VA Form 21-686c)

ICR 202111-2900-008 · OMB 2900-0043 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 21-686c Application Request to Add and/or Remove Dependents (VA Form 21-686c) Form Modified Repair queued
2022-15667.pdf Supplementary Document Uploaded 2022-07-26 Repair queued
2022-10727.pdf Supplementary Document Uploaded 2022-05-19 Repair queued
2900-0043, Supporting Statement (VAF 21-686c)(5-24-22).docx Supporting Statement A Uploaded 2022-05-24 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28162 Application Request to Add and/or Remove Dependents (VA Form 21-686c) Form Modified
ICR Details
2900-0043 202111-2900-008
Received in OIRA 201808-2900-002
VA VBA-COMP-NK
Application Request to Add and/or Remove Dependents (VA Form 21-686c)
Reinstatement with change of a previously approved collection   No
Regular 07/26/2022
  Requested Previously Approved
36 Months From Approved
369,162 0
184,581 0
0 0
VA Form 21-686c is used to gather the necessary information to determine eligibility for additional benefits for dependents. Without this information, entitlement to these benefits could not be determined.
US Code: 38 USC 1115 Name of Law: Additional Compensation for Dependents
   US Code: 38 USC 501(a) Name of Law: Rules and Regulations
  
None
Not associated with rulemaking
  87 FR 30560 05/19/2022
87 FR 15667 07/22/2022
No
1
IC Title Form No. Form Name
Application Request to Add and/or Remove Dependents (VA Form 21-686c) VA Form 21-686c Application Request to Add and/or Remove Dependents
  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 369,162 0 0 143,162 0 226,000
Annual Time Burden (Hours) 184,581 0 0 71,581 0 113,000
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.
$9,976,719
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.
07/26/2022