View Information Collection Request (ICR) Package

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: 2900-0101	ICR Reference No: 201708-2900-012
Status: Historical Active	Previous ICR Reference No: 201404-2900-008
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Eligibility Verification Reports (EVRs)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/25/2018
	Date Received in OIRA: 05/01/2018
Terms of Clearance: VA is reminded that labor costs should not be included in the burden cost estimate. In addition, a reduction to the estimated length of time required to fill out a form, without changes that reduce/alter the data elements requested, is not a "deregulatory" action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	69,000	0	219,000
Time Burden (Hours)	34,500	0	113,075
Cost Burden (Dollars)	0	0	2,713,800

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Eligibility Verification Reports	VA Form 21P-0519C-1, VA Form 21P-0519S-1 (Spanish), VA Form 21P-0519C-1 (Spanish), VA Form 21P-0519S-1, VA Form 21P-0510, VA Form 21P-0510 (Spanish), VA Form 21P-0512S-1, VA Form 21P-0512S-1 (Spanish), VA Form 21P-0513-1 (Spanish), VA Form 21P-0514-1, VA Form 21P-0514-1 (Spanish), VA Form 21P-0517-1, VA Form 21P-0512V-1, VA Form 21P-0513-1, VA Form 21P-0516-1, VA Form 21P-0516-1 (Spanish), VA Form 21P-0517-1 (Spanish), VA Form 21P-0518-1, VA Form 21P-0518-1 (Spanish)	, , , , , , , , , , , , , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	69,000	219,000	-150,000
Annual Time Burden (Hours)	34,500	113,075	-78,575
Annual Cost Burden (Dollars)	0	2,713,800	-2,713,800

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: VBA conducted a program review to determine the number of forms received in a given year. VBA determined it regularly receives fewer of the forms listed in this collection than previously reported. VBA also conducted a review of the time burden of each form in this collection, and determined the average time burden to be 30 minutes for each form, which is less than the previously reported time burden for some of the forms.

Annual Cost to Federal Government: $1,800,095

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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