2900-0001 Supporting Statement VAFs 526 526b 9-12-13

Supporting Statement for

Veteran’s Application for Compensation and/or Pension, VA Form 21-526, Veteran’s Supplemental Claim Application, 21-526b, and Authorization and Consent to Release Information to the Department of Veterans Affairs, 21-4142

(2900-0001)

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 dependents and/or beneficiaries. Title 38 U.S.C. 5101(a) provides that a specific claim in the form provided by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by the Secretary. VA Form 21-526 is the prescribed form for initial disability claims. VA Form 21-526b is the prescribed form for supplemental disability or ancillary benefit claims.

2. VA Form 21-526 and 21-526b are used to gather the necessary information to determine a veteran’s eligibility, dependency, and income, as applicable, for the compensation and/or pension benefit sought. Without this information, determination of entitlement would not be possible. In order to expedite and streamline the claims adjudication process, VA proposes to codify in its regulations the requirement that claimants submit these forms to claim compensation and/or pension benefits on VA Form 21-526 or supplemental benefits on VA Form 21-526b.

3. The Department is in process of adding several VA Forms to the Veterans Online Applications (VONAPP). VONAPP allows applicants to view, print, and submit applications electronically to VBA. VA Form 21-526 is one of the forms already available in the VONAPP. Due to limited resources, VA Form 21-526b is not currently available in VONAPP. The form will be added to VONAPP when resources become available. VA Form 21-4142 is used to request medical treatment records from private doctors, hospitals, physicians, etc. VA does not currently have in place an electronic signature infrastructure. Therefore, VA Form 21-4142, cannot at this time be added to VONAPP because the form requires the original signature of the beneficiary/claimant in order for VA to obtain these medical records due to Health Insurance Portability and Accountability Act (HIPAA) enacted by Congress in 1996.

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. This form was redesigned into a “user friendly” form, incorporating plain English, to comply with the President’s Memorandum of June 1, 1998, Plain Language in Government Writing.

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 July 24, 2009, pages 36828-36829 for VA Form 26-526b and on September 29, 2009, pages 49916-49917 for VA Form 21-526 and 21-4142. No comments were received.

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 “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).

11. There are no questions of a sensitive nature.

12. Estimate of Information Collection Burden.

a. Number of yearly respondents is estimated at a total of 304,325 (83,855 for VAF 21-526 and 3,292 for VAF 21-4142, and 217,178 for VAF 21-526b).

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

c. Annual burden is 138,413 hours (83,855 for VAF 21-526, 263 for 21-4142, and 54,295 for VAF 21-526b) hours.

d. The estimated completion time is 60 minutes for VA Form 21-526, 15 minutes for VA Form 21-526b and 5 minutes for VA Form 21-4142.

e. The total estimated cost to respondents is $2,076,193 (138,413x $15 per hour).

13. This submission does not involve any recordkeeping costs.

14. Estimated Costs to the Federal Government:

a. Processing/Analyzing costs $3,881,097

(GS- 9/5 @ $28.04 x 83,855 x 60/60 minutes = $2,351,294)

(GS- 9/5 @ $28.04 x 217,178 x 15/60 minutes = $1,522,418)

(GS- 9/5 @ $28.04 x 3,292 x 5/60 minutes = $7,385)

b. Printing and production cost ($90 per thousand) $27,389

c. Total cost to government $3,908,486

15. The increase in burden is due to the Notice of Proposed Rulemaking (NPRM) RIN 2900-AO81, “Standard Claims and Appeals Forms” which proposes to require all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is proposing to codify its regulations to standardize the use of all VA forms, to include VA Forms 21-526 and 21-526b. Currently, other than for the initial original claim, VA does not require that claimants submit any subsequent claim on a prescribed VA form. Although there is no substantive change in these forms, VA expects a change in the number of respondents submitting VA Forms 21-526 and 21-526b on account of VA’s electronic claims processing system which uses another form, i.e., VA Form 21-526EZ, that contains the 38 U.S.C. 5103 notices to claimants and that essentially combines the existing VA Form 21-526 and VA Form 21-526b together. The total estimated costs to respondents and the federal government have changed as shown in paragraphs 12 and 14 of this statement.

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

17. The collection instrument, VA Form 21-526, 526b and 21-4142, 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 21-526, 526b and 21-4142.

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

B. Collection of Information Employing Statistical Methods

The data collection does not employ statistical methods.