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OMB Control No: 2900-0849	ICR Reference No: 202512-2900-006
Status: Received in OIRA	Previous ICR Reference No: 202210-2900-006
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-KM
Title: Alternate Signer Certification (VA Form 21-0972)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2026
Responses	22,278	18,575
Time Burden (Hours)	5,570	4,644
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	22,278	18,575	3,703
Annual Time Burden (Hours)	5,570	4,644	926
Annual Cost Burden (Dollars)	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: The respondent burden has increased due to the estimated number of receivables averaged over the past year.

Annual Cost to Federal Government: $167,965

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: Dorothy Glasgow 240 205-5190 dorothy.glasgow@va.gov

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