Fiduciary Statement in Support of Appointment

ICR 201107-2900-026

OMB: 2900-0670

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2012-01-12
IC Document Collections
IC ID
Document
Title
Status
28948 Modified
ICR Details
2900-0670 201107-2900-026
Historical Active 200810-2900-003
VA 2900-0670
Fiduciary Statement in Support of Appointment
Extension without change of a currently approved collection   No
Regular
Approved without change 03/27/2012
Retrieve Notice of Action (NOA) 01/12/2012
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved 03/31/2012
7,500 0 7,500
1,875 0 1,875
0 0 0

VA Form 21-0792 will be completed by individuals who are seeking to be appointed as fiduciaries (payees) of VA beneficiaries. The information collected by this form will be used by VA to determine whether an individual is an appropriate fiduciary for a VA beneficiary.

PL: Pub.L. 108 - 454 Page 118 STAT. 3598 Name of Law: VETERANS BENEFITS IMPROVEMENT ACT OF 2004
  
None

Not associated with rulemaking

  76 FR 191 10/03/2011
77 FR 2 01/04/2012
No

1
IC Title Form No. Form Name
Fiduciary Statement in Support of Appointment VA Form 21-0792 Fiduciary Statement In Support of Appointment

  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 7,500 7,500 0 0 0 0
Annual Time Burden (Hours) 1,875 1,875 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$102,906
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.
01/12/2012


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