Request for Employment Information in Connection with a Claim for Disability Benefits

Forms and Documents

Document Name	Status
Form VA Form Letter 29- Request for Employment Information in Connection with a Claim for Disability Benefits Form	Modified
2900-0066 justification.doc Supporting Statement A	2010-09-21

IC Document Collections

IC ID	Document Title	Status
28208	Request for Employment Information in Connection with a Claim for Disability Benefits Form	Modified

ICR Details

OMB Control No: 2900-0066	ICR Reference No: 201006-2900-004
Status: Historical Inactive	Previous ICR Reference No: 200707-2900-030
Agency/Subagency: VA	Agency Tracking No: 2900-0066
Title: Request for Employment Information in Connection with a Claim for Disability Benefits
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/05/2010
	Date Received in OIRA: 09/24/2010
Terms of Clearance: In accordance with 5 CFR 1320, the information collection request was withdrawn at the agency's request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	36 Months From Approved	12/07/2010
Responses	5,167	0	5,167
Time Burden (Hours)	862	0	862
Cost Burden (Dollars)	0	0	0

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Abstract: The form is designed for use by VA to determine insured's eligibility for insurance benefits. The information is authorized by law, Title 38, USC Sections 1912, 1915, 1942 and 1948.

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Authorizing Statute(s): US Code: 38 USC Section 1912 Name of Law: Total disability waiver
   US Code: 38 USC Section 1915 Name of Law: Total disability income provision
   US Code: 38 USC Section 1942 Name of Law: Plans of insurance
   US Code: 38 USC Section 1948 Name of Law: Total disability provision
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 121	06/24/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 168	08/31/2010
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
Request for Employment Information in Connection with a Claim for Disability Benefits	VA Form Letter 29-459	Request for Employment Information in Connection with a Claim for Disability Benefits

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $20,524

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 09/24/2010

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