Information from Remarried Widow(er) (VA Form 21-4103)

ICR 201311-2900-009

OMB: 2900-0038

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2014-03-13
IC Document Collections
IC ID
Document
Title
Status
28149 Modified
ICR Details
2900-0038 201311-2900-009
Historical Active 201103-2900-012
VA 2900-0038 VBA-COMP-NK
Information from Remarried Widow(er) (VA Form 21-4103)
Revision of a currently approved collection   No
Regular
Approved without change 08/05/2014
Retrieve Notice of Action (NOA) 06/17/2014
  Inventory as of this Action Requested Previously Approved
08/31/2017 36 Months From Approved 08/31/2014
1,000 0 1,000
334 0 334
0 0 0

VA Form 21-4103 is used to gather information that is necessary to determine whether a deceased veteran's child is eligible for death pension upon remarriage of the surviving spouse.

US Code: 38 USC 1503 Name of Law: Determination with Respect to Annual Income
   US Code: 38 USC 1543 Name of Law: Net worth limitation
   US Code: 38 USC 1542 Name of Law: Children of veterans of a period of war.
  
None

Not associated with rulemaking

  78 FR 242 12/17/2013
79 FR 108 06/05/2014
No

1
IC Title Form No. Form Name
Information from Remarried Widow(er) VA Form 21-4103 Information From Remarried Widower

  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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 334 334 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$32,840
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.
06/17/2014


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