View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No: 2900-0652	ICR Reference No: 202606-2900-010
Status: Received in OIRA	Previous ICR Reference No: 202305-2900-006
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-KM
Title: Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/15/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	12,847	17,367
Time Burden (Hours)	2,141	2,895
Cost Burden (Dollars)	0	0

Authorizing Statute(s): US Code: 38 USC 1115(1)(E) Name of Law: Aid and attendance
   US Code: 38 USC 1311(c) Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1315(h) Name of Law: Dependency and Indemnity compensation to parents
   US Code: 38 USC 5503 Name of Law: Hospitalized veterans and estates of incompetent institutionalized veterans
   US Code: 38 USC 501(a)(2) Name of Law: Rules and regulations
   US Code: 38 USC 1502 Name of Law: Determination with respect to disability

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	12,847	17,367	-4,520
Annual Time Burden (Hours)	2,141	2,895	-754
Annual Cost Burden (Dollars)	0	0	0

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 has decreased since the previous approval due to the decline of the estimated number of receivables averaged over the past year.

Annual Cost to Federal Government: $330,372

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

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.