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Federal forms, ICRs, and supporting documents

Information Collection Request

Residency Verification Report-Veterans and Survivors (Form Letter 21-914)

ICR 202309-2900-008 · OMB 2900-0655 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form VA FL 21-914 Residency Verification Report-Veterans and Survivors (FL21-914) Form Modified Repair queued
2023-26548, 30-Day FRN (2900-0655).pdf Supplementary Document Uploaded 2023-12-06 Repair queued
2023-21522, 60-Day FRN (2900-0655).pdf Supplementary Document Uploaded 2023-09-29 Repair queued
2900-0655, Supporting Statement (FL21-914).docx Supporting Statement A Uploaded 2023-12-06 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28931 Residency Verification Report-Veterans and Survivors (FL21-914) Form Modified
ICR Details
2900-0655 202309-2900-008
Received in OIRA 202006-2900-005
VA VBA-COMP-NK
Residency Verification Report-Veterans and Survivors (Form Letter 21-914)
Revision of a currently approved collection   No
Regular 12/06/2023
  Requested Previously Approved
36 Months From Approved 01/31/2024
900 1,250
75 417
0 613
Form Letter 21-914 gathers the information necessary to verify that a Filipino veteran or beneficiary who is receiving benefits at the full-dollar rate based on U.S. residency continues to meet the residency requirements. The proper rate of payment could not be determined without this information.
US Code: 38 USC 107 Name of Law: Certain service deemed not to be active service
  
None
Not associated with rulemaking
  88 FR 67454 09/29/2023
88 FR 26548 12/04/2023
No
1
IC Title Form No. Form Name
Residency Verification Report-Veterans and Survivors (FL21-914) VA FL 21-914 Residency Verification Report - Veterans and Survivors
  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 900 1,250 0 -350 0 0
Annual Time Burden (Hours) 75 417 0 -342 0 0
Annual Cost Burden (Dollars) 0 613 0 -613 0 0
No
Yes
Miscellaneous Actions
The burden estimate has decreased due to 1) a decrease in the number of minutes it takes to fill out the form, and 2) the respondent total has also decreased since the previous approval due to the estimated number of receivables averaged over the past year.
$11,506
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.
12/06/2023