Income Verification

ICR 201209-2900-012

OMB: 2900-0518

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2012-10-12
IC Document Collections
IC ID
Document
Title
Status
28700 Modified
ICR Details
2900-0518 201209-2900-012
Historical Active 200909-2900-010
VA 2900-0518
Income Verification
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/14/2013
Retrieve Notice of Action (NOA) 03/05/2013
This is approved as a reinstatement without change.
  Inventory as of this Action Requested Previously Approved
05/31/2016 36 Months From Approved
30,000 0 0
15,000 0 0
0 0 0

VA Form 21-0161a is used to gather information from employers to determine entitlement to income-dependent benefits.

US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
   US Code: 38 USC 6102 Name of Law: Fraudulent acceptance of payments
  
None

Not associated with rulemaking

  77 FR 204 10/22/2012
78 FR 21 01/31/2013
No

1
IC Title Form No. Form Name
Income Verification 21-0161A Income Verification

  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 30,000 0 0 0 0 30,000
Annual Time Burden (Hours) 15,000 0 0 0 0 15,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,414,047
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@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.
03/05/2013


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