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: 2900-0500	ICR Reference No: 202009-2900-017
Status: Historical Active	Previous ICR Reference No: 202009-2900-001
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-MS
Title: Mandatory Verification of Dependents (VA Form 21-0538)
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: 02/04/2021
	Date Received in OIRA: 12/30/2020
Terms of Clearance: In VA's next extension, revision, or reinstatement request, VA shall explain how this form is consistent with VA's directive on collection of social security numbers. In VA's next printing of these forms, VA shall modify "Your obligation to respond is required to obtain or retain benefits." to "Your response is required to obtain or retain benefits." VA shall continue to accept forms with the old language.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2024	36 Months From Approved	02/28/2021
Responses	175,400	0	540,000
Time Burden (Hours)	29,233	0	90,000
Cost Burden (Dollars)	438,490	0	1,349,968

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	175,400	540,000	-364,600
Annual Time Burden (Hours)	29,233	90,000	-60,767
Annual Cost Burden (Dollars)	438,490	1,349,968	-911,478

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: The burden estimate has decreased due to the restructured batch print cycle time period changing to eight years.

Annual Cost to Federal Government: $3,902,562

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

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