View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0652	ICR Reference No: 201602-2900-005
Status: Historical Active	Previous ICR Reference No: 201304-2900-024
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-NK
Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/17/2017
	Date Received in OIRA: 09/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	02/28/2017
Responses	61,125	0	50,000
Time Burden (Hours)	10,188	0	8,333
Cost Burden (Dollars)	201,519	0	0

Authorizing Statute(s): US Code: 38 USC 1502 Name of Law: Determination with respect to disability
   US Code: 38 USC 1115(1)(E) Name of Law: Aid and attendance
   US Code: 38 USC 1311(c) Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1315(h) Name of Law: Dependency and Indemnity compensation to parents
   US Code: 38 USC 5503 Name of Law: Hospitalized veterans and estates of incompetent institutionalized veterans
   US Code: 38 USC 501(a)(2) Name of Law: Rules and regulations

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	61,125	50,000	11,125
Annual Time Burden (Hours)	10,188	8,333	1,855
Annual Cost Burden (Dollars)	201,519	0	201,519

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 hours per response have not changed (10 minutes or 0.16667 hours). VBA re-evaluated the number of these application forms received per year, and increased the estimated number of responses from 50,000 to 61,125. The evaluation was based on actual claims data contained in VBA’s benefits database.

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