Application for Accreditation as Service Organization Representative

Forms and Documents

Document Name	Status
Form 21 Application for Accreditation as Service Organization Representative Form	Modified
VA Form 21.doc Supporting Statement A	2007-11-27

IC Document Collections

IC ID	Document Title	Status
28110	Application for Accreditation as Service Organization Representative Form	Modified

ICR Details

OMB Control No: 2900-0018	ICR Reference No: 200903-2900-003
Status: Historical Active	Previous ICR Reference No: 200603-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0018
Title: Application for Accreditation as Service Organization Representative
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/25/2009
	Date Received in OIRA: 03/04/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	36 Months From Approved	08/31/2009
Responses	4,780	0	2,400
Time Burden (Hours)	1,003	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: Application For Accreditation - representatives of service organizations use this form to apply for VA accreditation to represent claimants for benefits before VA.

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Authorizing Statute(s): US Code: 38 USC 5902 Name of Law: Recognition of representatives of organizations
   US Code: 38 USC 5903 Name of Law: Recognition with respect to particular claims
   US Code: 38 USC 5904 Name of Law: Recognition of agents and attorneys generally
   US Code: 38 USC 5901 Name of Law: Prohibition against acting as claims agent or attorneyion
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AM29	Final or interim final rulemaking	72 FR 197	10/12/2007

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 123	06/27/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 205	10/24/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Accreditation as Service Organization Representative	21	Application for Accreditation as Service Organization Representative

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ICR Summary of Burden

	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	4,780	2,400	0	20	2,360	0
Annual Time Burden (Hours)	1,003	600	0	10	393	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: VA Form 21, the adjustment is a result of a program requirement for the recertification of accredited representatives and agents every five years. For accreditation cancellation information, the program increase is a result of new regulations requiring service organizations to report the reasons for requesting cancellation of a representative's accreditation.

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Annual Cost to Federal Government: $29,288

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/04/2009

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