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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:
2900-0721
ICR Reference No:
202111-2900-009
Status:
Active
Previous ICR Reference No:
201712-2900-007
Agency/Subagency:
VA
Agency Tracking No:
VBA-COMP-NK
Title:
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)
Type of Information Collection:
Reinstatement with change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/21/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/18/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2026
36 Months From Approved
Responses
103,915
0
0
Time Burden (Hours)
51,958
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
VA Form 21-2680 is used to determine eligibility for the aid and attendance and/or housebound benefit. The purpose of this examination is to record manifestations and findings pertinent to the question of whether the claimant is housebound (confined to the home or immediate premises) or in need of the regular aid and attendance of another person. The report should be in sufficient detail for the VA decision makers to determine the extent that disease or injury produces physical or mental impairment, that loss of coordination or enfeeblement affects the ability: to dress and undress; to feed themselves; to attend to the wants of nature; or keep themselves ordinarily clean and presentable. Findings should be recorded to show whether the claimant is blind or bedridden. Whether the claimant seeks housebound or aid and attendance benefits, the report should reflect how well they ambulate, where they go, and what they are able to do during a typical day.
Authorizing Statute(s):
US Code:
38 USC 1115(1)(e)
Name of Law: Additional compensation for dependents
US Code:
38 USC 1311(d)
Name of Law: Dependency and indemnity compensation to a surviving spouse
US Code:
38 USC 1541(d)
Name of Law: Surviving spouses of veterans of a period of war
US Code:
38 USC 1541(e)
Name of Law: Surviving spouses of veterans of a period of war
US Code:
38 USC 1521(d)
Name of Law: Veterans of a period of war
US Code:
38 USC 1521(e)
Name of Law: Veterans of a period of war
US Code:
38 USC 1114
Name of Law: Rates of wartime disability compensation
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:
87 FR 67758
11/09/2022
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 2390
01/13/2023
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
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680)
VA Form 21-2680
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
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
103,915
0
0
89,915
0
14,000
Annual Time Burden (Hours)
51,958
0
0
44,958
0
7,000
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The respondent burden has increased due to the estimated number of receivables averaged over the past year.
Annual Cost to Federal Government:
$4,531,302
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?
No
Agency Contact:
Maribel Aponte 202 266-4688 maribel.aponte@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:
01/18/2023
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