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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:
2900-0572
ICR Reference No:
201903-2900-011
Status:
Historical Active
Previous ICR Reference No:
201508-2900-009
Agency/Subagency:
VA
Agency Tracking No:
VBA-COMP-NK
Title:
Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/14/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/27/2019
Terms of Clearance:
In its next revision or extension request, VA will modify the Privacy Act statement from "Your obligation to respond is required in order to obtain or retain benefits" to "Your response is required in order to obtain or retain benefits."
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2023
36 Months From Approved
Responses
430
0
0
Time Burden (Hours)
72
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
VA Form 21-0304 is used to gather information necessary to determine eligibility for a monetary allowance for a child born with spina bifida or certain birth defects who is a natural child of a Vietnam or certain Korea service veteran.
Authorizing Statute(s):
US Code:
38 USC Section 1805
Name of Law: Monetary allowance
US Code:
38 USC Section 1815
Name of Law: Monetary allowance
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:
84 FR 9413
03/14/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 11583
06/04/2019
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Application for Benefits for a Qualifying Veteran's Child Born with Disabilities
VA Form 21-0304
Application for Benefits for a Qualifying Veteran's Child Born with Disabilites
ICR Summary of Burden
Total Approved
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
430
0
0
0
0
430
Annual Time Burden (Hours)
72
0
0
0
0
72
Annual Cost Burden (Dollars)
0
0
0
0
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:
$13,393
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:
Danny Green 202 421-1354 danny.green2@va.gov
Common Form ICR:
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:
(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:
11/27/2019
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