View Information Collection Request (ICR) Package

OMB Control No: 2900-0059	ICR Reference No: 202009-2900-024
Status: Historical Active	Previous ICR Reference No: 201610-2900-008
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Statement of Person Claiming to Have Stood in Relation of Parent (VA Form 21P-524)
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: 04/07/2021
	Date Received in OIRA: 12/22/2020
Terms of Clearance: In VA's next revision, extension, or reinstatement request for this collection, VA shall: 1. Have reviewed all related collections (including 21P-509, 21-524, 21P-535) to consider whether there is overlap or duplication, and submit draft updates that ensure that each collection and related instructions indicates when respondents should complete that form versus when there is a different form that should be completing instead based on their circumstances. 2. Explain how VA collects the required income and net worth for those completing this collection, 21-524. 3. Consider whether VA imposes any recordkeeping requirements or regularly requires/collects information (such as tax filings) that should be included for PRA approval. The PRA covers collections of information from 10 or more persons through any mechanism, even if not included on a form, but does not include nonstandardized follow-up questions designed to clarify responses to approved collections of information.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2024	36 Months From Approved
Responses	400	0	0
Time Burden (Hours)	800	0	0
Cost Burden (Dollars)	16,180	0	0

Abstract: VA Form 21P-524 is used to gather information from claimants seeking service-connected survivors benefits as persons who stood in relation of parent to deceased veterans. This relationship must be established in order to meet basic eligibility requirements. The information collected will be used by VBA to evaluate a claimant’s parental relationship to a deceased Veteran when the claimant is not the Veteran’s natural mother or father or adopted mother or father.

Authorizing Statute(s): US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation

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 64231	10/09/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 83681	12/22/2020
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
Statement of Person Claiming to Have Stood in Relation of Parent (21P-524)	21P-524

ICR Summary of Burden

	Total Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses	400	400
Annual Time Burden (Hours)	800	800
Annual Cost Burden (Dollars)	16,180	16,180

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: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $23,410

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

View ICR - OIRA Conclusion