View Information Collection Request (ICR) Package
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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:
2900-0002
ICR Reference No:
202005-2900-015
Status:
Historical Active
Previous ICR Reference No:
201808-2900-001
Agency/Subagency:
VA
Agency Tracking No:
VBA-P&F-MS
Title:
Application for Veterans Pension (VA Form 21P-527EZ) and (VA Form 21P-527)
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:
01/19/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/02/2020
Terms of Clearance:
In the next revision, extension, or reinstatement request, VA shall modify the statement "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." In addition, VBA shall consult with VHA to determine if any of the information requested duplicates that collected or held by VHA, such as the VHA's income verification process or medical records.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2023
36 Months From Approved
10/31/2021
Responses
100,000
0
100,000
Time Burden (Hours)
56,250
0
56,250
Cost Burden (Dollars)
0
0
0
Abstract:
VA Form 21P-527EZ, is the prescribed form for claiming Veterans Pension under the Fully Developed Claim program. VA Form 21P-527 is used to gather the necessary information to determine a veteran’s eligibility for Veterans Pension. Without this information, VA will not be able to determine a Veteran’s eligibility to the benefit. A Veteran may also use this form to file a new Veterans Pension claim after VA has discontinued a previous pension award and the Veteran is requesting his or her benefits be reinstated.
Authorizing Statute(s):
US Code:
38 USC 1502
Name of Law: Determinations with respect to disability
US Code:
38 USC 1503
Name of Law: Determinations with respect to annual income
US Code:
38 USC 5101(a)
Name of Law: Claims and Forms
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:
85 FR 35996
06/12/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 60522
09/25/2020
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 Veterans Pension (VA Form 21P-527EZ),and (VA Form 21P-527)
VA Form 21P-527EZ, VA Form 21P-527
Application for Veteran's Pension
,
Application for Veteran's Pension
Income, Asset, and Employment Statement
21P-527
Income, Asset, and Employment Statement
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
100,000
100,000
0
25,000
-25,000
0
Annual Time Burden (Hours)
56,250
56,250
0
25,000
-25,000
0
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:
Overall burden not effected by consolidation adjustment. Previous burden estimate reinstated.
Annual Cost to Federal Government:
$4,532,305
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:
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:
12/02/2020
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