2900-0038 justification

Supporting Statement for VA Form 21-4103

Information from Remarried Widow(er)

(2900-0038)

A. Justification

1. The Department of Veterans Affairs (VA) through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services, established by law, for veterans, service personnel and their survivors. Death pension may be payable to eligible children of deceased veterans who served during a wartime period when there is not an eligible surviving spouse. Information is requested by this form under the authority of 38 U.S.C. 1503, (Determination with Respect to Annual Income), 1542 (Children of veterans of a period of war), and 1543 (Net worth limitation).

2. VA Form 21-4103 is used to gather information to determine if a child meets the requirements for death pension established under the law. The income and net worth of the child, remarried widow(er) and her/his spouse must be within the limits imposed by law.

3. VA Form 21-4103 is available on the One-VA web site in a fillable electronic format. VBA is currently hosting this form on a secure server and does not currently have the technology in place to allow for the complete submission of the form. Validation edits are performed to assure data integrity. Efforts within VA are underway to provide a mechanism to allow the information to be submitted electronically with a recognized signature technology. There currently is no utility process in place that will allow the data submitted on the form to be incorporated with an existing centralized legacy database.

4. Program reviews were conducted to identify potential areas of duplication; however, none were found to exist. There is no known Department or Agency which maintains the necessary information, nor is it available from other sources within our Department.

5. The collection of information does not involve small businesses or entities.

6. The VA compensation and pension programs require current information to determine eligibility for benefits. When a surviving spouse receiving death pension remarries, her/his entitlement to death pension is permanently lost. However, the deceased veteran’s child or children may be eligible to death pension if the income and net worth of the child or children, remarried widow(er) and her/his spouse meet income and net worth limits. If the collection were not conducted, VA would be unable to determine a child's eligibility for death pension once a surviving spouse remarries.

7. There is no special circumstance requiring collection in a manner inconsistent with 5 CFR 1320.6 guidelines.

8. The Department notice was published in the Federal Register on March 18, 2011, page 15053-15054. No comments were received in response to this notice.

9. No payments or gifts to respondents have been made under this collection of information.

10. The records are maintained in the appropriate Privacy Act System of Records identified as 58VA21/22/28,‘‘Compensation, Pension, Education, and Rehabilitation Records—VA ’’as set forth in Privacy Act Issuances, 1993 compilation found in 74 Fed. Reg. 117 (June 19, 2009).

11. There are no questions of a sensitive nature.

12. Estimate of Information Collection Burden.

a. Number of Respondents is estimated at 1,000 per year.

b. Frequency of Response is one time for most beneficiaries.

c. Annual burden is 334 hours.

d. The estimated completion time of 20 minutes is based on review by staff personnel and previous usage of this form.

e. The total estimated cost to respondents is $5,010 (334 hours x $15 per hour).

13. This submission does not involve any recordkeeping costs.

14. Estimated Costs to the Federal Government:

a. Processing/Analyzing costs $32,665

(GS-9/5 @ $28.04 x 1,000 x 60/60 minutes = $28,040)

(GS-5/5 @ $18.50 x 1,000 x 15/60 minutes = $ 4,625)

b. Printing and production cost $175

c. Total cost to government $32,840

15. There are no changes to the burden hours on this form.

16. The information collection is not for publication or tabulation use.

17. The collection instrument, VA Form 21-4103, may be reproduced and/or stocked by the respondents and veterans service organizations. This VA form does not display an expiration date, and if required to do so would result in unnecessary waste of existing stocks of this form. This form is submitted to OMB every 3 years. As such, this date requirement would also result in an unnecessary burden on the respondents and would delay Department action on the benefit being sought. VA also seeks to minimize its cost to itself of collecting, processing and using the information by not displaying the expiration date. For the reasons stated, VA continues to seek an exemption that waives the displaying of the expiration date on VA Form 21-4103.

18. This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

The Veterans Benefits Administration does not collect information employing statistical methods.