Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)

Forms and Documents

Document Name	Status
Form 21-535 Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) Form	Modified
2900-0005 Supporting Statement VAF 535 9-12-13.docx Supporting Statement A	2013-09-12

IC Document Collections

IC ID	Document Title	Status
28078	Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) Form	Modified

ICR Details

OMB Control No: 2900-0005	ICR Reference No: 201309-2900-007
Status: Historical Inactive	Previous ICR Reference No: 201107-2900-024
Agency/Subagency: VA	Agency Tracking No: 2900-0005 VBA-COMP-NK
Title: Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 12/13/2013
	Date Received in OIRA: 09/19/2013
Terms of Clearance: VA will resubmit the information collection at the final rule stage.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2015
Responses	3,600	0	3,600
Time Burden (Hours)	4,320	0	4,320
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-535 is used by surviving parents to apply for Dependency and Indemnity Compensation (DIC), death compensation, and/or accrued benefits. It would be impossible to determine eligibility for these benefits without this form.

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Authorizing Statute(s): US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 5121 Name of Law: Payment of certain accrued benefits upon death of a beneficiary
   US Code: 38 USC 501(a)(2) Name of Law: Rules and regulations
   US Code: 38 USC 1121 Name of Law: Death Compensation - Basic entitlement
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO81	Proposed rulemaking	78 FR 211	10/31/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 211	10/31/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)	21-535	Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: There is a change in the annual expected number of respondents 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 Form 21-535. 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 this form, VA expects a change in the number of respondents submitting VA Form 21-535 on account of VA's electronic claims processing system which will use another form, i.e., VA Form 21-534EZ, that contains the 38 U.S.C. 5103 notices to claimants. VA also expects that more respondents will be filing death benefit claims by parents in the fully developed claim program which requires the use of VA Form 21-534EZ.

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Annual Cost to Federal Government: $215,478

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/19/2013

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