Supporting Statement for VA Form 21-8049
Request for Details of Expenses
(2900-0138)
A. Justification
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 dependents and/or beneficiaries. 38 U.S.C. 1503, Determinations With Respect to Annual Income, provides the statutory basis for the income aspect of the disability pension program. The regulatory basis is found at 38 C.F.R. 3.272.
VA Form 21-8049 is used to gather the necessary information to determine the amounts of any deductible expenses paid by the claimant and/or commercial life insurance received in order to adjust the annual income. Pension is an income-based program, and the payable rate depends on annual income. It would be impossible to administer the pension program without the collection of this information.
VA Form 21-8049 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.
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.
The collection of information does not involve small businesses or entities.
This form solicits the necessary information to determine the amount of any deductible expenses paid by the claimant and/or commercial life insurance received to calculate the current rate of pension. Without this information, VA would be unable to authorize pension benefits.
There is no special circumstance requiring collection in a manner inconsistent with 5 CFR 1320.6 guidelines.
The Department notice was published in the Federal Register on May 20, 2013, page 29439. No outside consultations were solicited as no major changes are being made to the form. Field stations have not reported any difficulty on the part of respondents in using this form. No comments were received.
No payments or gifts to respondents have been made under this collection of information.
The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 on June 19, 2009, and last amended at 77 FR 42593 (July 19, 2012).
There are no questions of a sensitive nature.
Estimate of Information Collection Burden.
a. Number of Respondents is estimated at 22,800 per year.
b. Frequency of Response is one time for most beneficiaries.
c. Annual burden is 5,700 hours.
d. The estimated completion time of 15 minutes is based on review by staff personnel and previous usage of this form.
e. The total estimated cost to respondents is $85,500 (5,700 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 $579,367
(GS-9/5 @ $28.04 x 22,800 x 30/60 minutes = $319,656)
(GS-5/5 @ $18.50 x 22,800 x 25/60 minutes = $175,750)
(GS-3/5 @ $14.73 x 22,800 x 15/60 minutes = $ 83,961)
b. Printing and production cost $2052
c. Total cost to government $581,419
15. There is no change in the reporting burden.
16. The information collection is not for publication or tabulation use.
17. The collection instrument, VA Form 21-8049, 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 21-8049.
This submission does not contain any exceptions to the certification statement.
B. Collection of Information Employing Statistical Methods
1. The Veterans Benefits Administration does not collect information employing statistical methods.
| File Type | application/msword |
| File Title | SF 83 SS VAF 21-8926 |
| Author | Veterans Benefits Administrat |
| Last Modified By | James, Belinda, VBAVACO |
| File Modified | 2013-08-01 |
| File Created | 2013-04-19 |