ELIGIBILITY VERIFICATION REPORT

ICR 198904-2900-010

OMB: 2900-0101

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
147051 Migrated
ICR Details
2900-0101 198904-2900-010
Historical Active 198706-2900-001
VA
ELIGIBILITY VERIFICATION REPORT
Revision of a currently approved collection   No
Regular
Approved without change 06/09/1989
Retrieve Notice of Action (NOA) 04/04/1989
  Inventory as of this Action Requested Previously Approved
01/31/1992 01/31/1992 06/30/1990
1,856,250 0 2,016,750
464,063 0 403,350
0 0 0

THIS SERIES OF FORMS IS USED TO OBTAIN ELIGIBILITY INFORMATION FROM RECIPIENTS OF THE VA'S INCOME-BASE PROGRAMS AT LEAST ONCE EACH YEAR. THE FORMS REQUEST FAMILY INCOME, NE WORTH, MARITAL STATUS, AND THE STATUS OF DEPENDENTS. THE DIFFERENT FORMATS ARE DESIGNED TO ELICIT THE APPROPRIATE INFORMATION FROM EACH INDIVIDUAL BENEFICIARY.

None
None


No

1
IC Title Form No. Form Name
ELIGIBILITY VERIFICATION REPORT VA 21-0510, THRU, 21-0519-1, 2189-20, THROUGH

  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 1,856,250 2,016,750 0 0 -160,500 0
Annual Time Burden (Hours) 464,063 403,350 0 0 60,713 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$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.
04/04/1989


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