Request for Employment Information in Connection with Claim for Disability Benefits

ICR 200707-2900-015

OMB: 2900-0065

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
2900-0065 200707-2900-015
Historical Active 200408-2900-007
VA 2900-0065
Request for Employment Information in Connection with Claim for Disability Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 01/02/2008
Retrieve Notice of Action (NOA) 11/14/2007
Approved consistent with the following terms of clearance, in the next submission of this clearance to OMB for review VA shall report on Dept. efforts to provide a fully electronic version of associated forms to respondents.
  Inventory as of this Action Requested Previously Approved
01/31/2011 36 Months From Approved 12/31/2007
60,000 0 60,000
15,000 0 15,000
0 0 0

VA Form 21-4192 is used to gather necessary employment information from veterans' employers so VA can determine eligibility to increased disability benefits based on unemployability.

US Code: 38 USC 1502 Name of Law: Determinations with Respect to Disability
  
None

Not associated with rulemaking

  72 FR 145 07/30/2007
72 FR 196 10/11/2007
No

  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 60,000 60,000 0 0 0 0
Annual Time Burden (Hours) 15,000 15,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$3,455,879
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov

  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.
11/14/2007


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