Exam for Housebound Status or Permanent Need for Regular Aid and Attendance

ICR 201107-2900-023

OMB: 2900-0721

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
2900-0721 201107-2900-023
Historical Active 200804-2900-022
VA 2900-0721
Exam for Housebound Status or Permanent Need for Regular Aid and Attendance
Extension without change of a currently approved collection   No
Regular
Approved without change 03/02/2012
Retrieve Notice of Action (NOA) 12/14/2011
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved 03/31/2012
14,000 0 14,000
7,000 0 7,000
0 0 0

This form will be used to gather medical information on behalf of beneficiaries or claimants who are requesting the aid and attendance or housebound benefit and who receive treatment from private doctors or physicians.

US Code: 38 USC 1521(d) Name of Law: Veterans of a period of war
   US Code: 38 USC 1521(e) Name of Law: Veterans of a period of war
   US Code: 38 USC 1114 Name of Law: Rates of wartime disability compensation
   US Code: 38 USC 1115(1)(e) Name of Law: Additional compensation for dependents
   US Code: 38 USC 1311(d) Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1541(d) Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1541(e) Name of Law: Surviving spouses of veterans of a period of war
  
None

Not associated with rulemaking

  76 FR 183 09/21/2011
76 FR 228 11/28/2011
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 14,000 14,000 0 0 0 0
Annual Time Burden (Hours) 7,000 7,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$641,624
No
No
No
No
No
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.
12/14/2011


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