OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)

ICR 202404-2900-004 · OMB 2900-0094 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169) Form Modified Repair queued
30-DAY FRN 2900-0094.pdf Supplementary Document Uploaded 2024-07-08 Missing upstream
2024-09376, 60-Day FRN (VAF21-4169).pdf Supplementary Document Uploaded 2024-06-27 Repair queued
2900-0094, Supporting Statement (VAF21-4169) v1.docx Supporting Statement A Uploaded 2024-07-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
28260 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169) Form Modified
ICR Details
2900-0094 202404-2900-004
Received in OIRA 202009-2900-021
VA VBA-COMP-KM
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)
Revision of a currently approved collection   No
Regular 07/08/2024
  Requested Previously Approved
36 Months From Approved 07/31/2024
849 1,000
212 250
0 0
VA Form 21-4169 is used to gather the necessary information to determine whether a claimant’s service qualifies as service in the Commonwealth Army of the Philippines or recognized guerrilla organizations. The form is used for the sole purpose of collecting the information needed to determine eligibility for benefits based on such service, including service information, proof of service, place of residence, and membership in pro-Japanese, pro-German, or anti-American Filipino organizations. Without this information, determination of entitlement would not be possible.
US Code: 38 USC 101 Name of Law: Definitions
   US Code: 38 USC 6104 Name of Law: Forfeiture for treason
  
None
Not associated with rulemaking
  89 FR 35306 05/01/2024
89 FR 56023 07/08/2024
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 849 1,000 0 -151 0 0
Annual Time Burden (Hours) 212 250 0 -38 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The respondent burden has decreased due to the estimated number of receivables averaged over the past year.
$9,673
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.
07/08/2024