Approved with
revised form faxed to OMB on 3/20/02.
Inventory as of this Action
Requested
Previously Approved
03/31/2005
03/31/2005
03/31/2002
7,900
0
7,900
1,975
0
1,975
0
0
0
VA Form 21-4183 is used by a child
under age 18 where the surviving spouse was not or is no longer
entitled to benefits or by a child age 18 or over regardless of the
surviving spouse's entitlement. this form is used in lieu of VA
Form 21-534, Application for Dependency and Indemnity Compensation
or Death Pension by Widow(er) or Child.
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.