View Information Collection Request (ICR) Package

OMB Control No: 2900-0881	ICR Reference No: 202007-2900-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-CS-MS
Title: Lay/Witness Statement (VA Form 21-10210)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 07/31/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2020
	Date Received in OIRA: 07/27/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	100,000	0	0
Time Burden (Hours)	16,667	0	0
Cost Burden (Dollars)	0	0	0

Abstract: VA Form 21-10210 will be used by the claimant to gather lay or witness statements that support an existing claim for benefits or services. Without this information, VA may not be able to efficiently and successfully process claims that may require additional statements associated with a claim for benefits or services.

Emergency Justfication: (1) Veteran Ability to submit Claims Impacted Due to COVID-19. Local travel restrictions and COVID-19 mandated health & safety precautions may impact Veterans' and claimants' abilities to file forms, documents, and other responses in connection with VA Claims & Appeals. (2) Veterans Benefits Administration (VBA) anticipates a potential increase in the submission of claims during and after the state of emergency for COVID-19. In an effort to address the effects of COVID-19 on claims processing for Veterans and claimants and to provide better, faster, and more efficient services, VBA proposes to align our modernization efforts with the way we currently receive certain types of veteran/claimant information. VBA has identified the need for 3 new forms that will reduce the submission of the current free-text form which does not support our current automation processing. By creating these new forms that do support the existing automation processes we will be able to provide faster and more efficient delivery of service to Veterans and claimants in response to the anticipated increase in claims related submissions that were affected by the COVID-19 pandemic. (3) This new form will also enable VBA to process Veteran data faster due to the use of computerized Optical Character Recognition (OCR) which is the automated process to "read" forms for information upload into VBA systems.

Authorizing Statute(s): US Code: 38 USC 501 Name of Law: Rules and Regulations
   US Code: 38 USC 5103 Name of Law: Due Process
   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
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
Lay/Witness Statement (VA Form 21-10210)	VA Form 21-10210

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	100,000	100,000
Annual Time Burden (Hours)	16,667	16,667
Annual Cost Burden (Dollars)	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: New collection request.

Annual Cost to Federal Government: $2,224,950

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? Yes

Agency Contact: Danny Green 202 421-1354 danny.green2@va.gov

View ICR - OIRA Conclusion