View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0668	ICR Reference No: 201708-2900-005
Status: Historical Active	Previous ICR Reference No: 201312-2900-012
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Supplemental Income Questionnaire (For Philippine Claims Only) (VA Form 21P-0784)
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: 03/05/2018
	Date Received in OIRA: 12/27/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved
Responses	120	0	0
Time Burden (Hours)	30	0	0
Cost Burden (Dollars)	716	0	0

Authorizing Statute(s): US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1542 Name of Law: Children of veterans of a period of war
   US Code: 38 USC 107 Name of Law: Certain service deemed not to be active service
   US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
   US Code: 38 USC 1521 Name of Law: Veterans of a period of war

Citations for New Statutory Requirements: None

Annual Cost to Federal Government: $2,980

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

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