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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
2900-0001
ICR Reference No:
201712-2900-005
Status:
Historical Inactive
Previous ICR Reference No:
201407-2900-015
Agency/Subagency:
VA
Agency Tracking No:
VBA-COMP-NK
Title:
Veteran's Supplemental Claim Application (VA Form 21-526b)
Type of Information Collection:
Reinstatement with change of a previously approved collection
Common Form ICR:
Yes
Type of Review Request:
Regular
OIRA Conclusion Action:
Improperly submitted and continue
Conclusion Date:
06/25/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/16/2018
Terms of Clearance:
This is being returned because it was submitted as a "Request for Common Form" but it is not a common form. The agency may resubmit it as a reinstatement.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2017
36 Months From Approved
Responses
433,433
0
0
Time Burden (Hours)
149,182
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
VA Form 21-526b is used to gather the necessary information to determine a veteran's eligibility, dependency, and income, as applicable, for the compensation and/or pension benefit sought. Without this information, determination of entitlement would not be possible.
Authorizing Statute(s):
US Code:
38 USC Section 5101(a)
Name of Law: Claims and forms
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:
82 FR 28546
06/22/2017
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 44028
09/20/2017
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
Veteran's Supplemental Claim Application (VA Form 21-526b)
VA Form 21-526b
Veterans Supplemental Claim Application
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The decrease in burden for this control number is because it previously contained four forms. VA Forms 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, have been separated from this control number. A new control number has been assigned for these forms. VA Form 21-526, Veterans Application for Compensation and/or Pension, has been removed due to agency discretion. This form will be discontinued.
Annual Cost to Federal Government:
$11,923,796
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?
Uncollected
Agency Contact:
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov
Common Form ICR:
Yes
Description/Changes for Common Form Usage:
VA Forms 21-526b is being revised to include new standardization data points; to include optical character recognition boxes. This is a non-substantive change. The contention questions in Section II of VA Form 21-526b has been revised to match other application forms to stay consistent. Note: This control number previously contained four forms. VA Forms 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, have been separated from this control number. A new control number has been assigned to these forms. VA Form 21-526, Veterans Application for Compensation and/or Pension, has been removed due to agency discretion. This form will be discontinued.
Approved RCFs using this ICR
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
04/16/2018
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