APPLICATION FOR AMOUNTS DUE ESTATES OF PERSONS ENTITLED TO BENEFITS

ICR 198101-2900-019

OMB: 2900-0064

Federal Form Document

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ICR Details
2900-0064 198101-2900-019
Historical Active 197706-2900-002
VA
APPLICATION FOR AMOUNTS DUE ESTATES OF PERSONS ENTITLED TO BENEFITS
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/22/1981
Approved with change 01/22/1981
Retrieve Notice of Action (NOA) 01/22/1981
  Inventory as of this Action Requested Previously Approved
06/30/1982 06/30/1982 06/30/1982
1,000 0 1,500
250 0 375
0 0 0

THIS APPLICATION IS REQUIRED TO FILE FOR PAYMENT OF ACCRUED BENEFITS, DUE A VETERAN AT DEATH, AS REIMBURSEMENT FOR EXPENSES INCURRED FOR LAST SICKNESS AND BURIAL OF THE DECEASED VETERAN. THE INFORMATION IS NECESSARY TO DETERMINE IF THERE ARE ANY ELIGIBLE SURVIVING RELATIVES, AMOUNTS OF EXPENSES ALREADY PAID, AND ANY OUTSTANDING AMOUNTS AND WHO ARE THE UNPAID CREDITORS. AUTHORITY IS 38 C.F.R. 3.262, 3.340 AND 3.342

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR AMOUNTS DUE ESTATES OF PERSONS ENTITLED TO BENEFITS 21-609

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000 1,500 0 -500 0 0
Annual Time Burden (Hours) 250 375 0 -125 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/22/1981


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