Approved
consistent with the following terms of clearance: in the next
submission of this collection of information VA shall report to OMB
on the status of offering users fully integrated electronic
versions of forms associated with this collection which may be
completed and submitted online in compliance with the Government
Paperwork Elimination Act of 1998.
Inventory as of this Action
Requested
Previously Approved
08/31/2008
08/31/2008
08/31/2005
752,000
0
752,000
188,000
0
188,000
0
0
0
VA Form 21-4138 is used to provide
self-certified statements in support of various types of claims
processed by VA. Statements submitted by or on behalf of a claimant
should contain certification by the respondent that the information
provided is true and correct. This form facilitates claims
processing by providing a uniform format for the certification
statement.
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.