Disability Benefits Questionnaires (Group 2)

ICR 201312-2900-023

OMB: 2900-0776

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2014-07-09
Supplementary Document
2014-03-10
Supplementary Document
2012-01-11
Justification for No Material/Nonsubstantive Change
2012-01-09
Justification for No Material/Nonsubstantive Change
2011-12-15
Supporting Statement A
2014-09-03
IC Document Collections
IC ID
Document
Title
Status
195946 Modified
ICR Details
2900-0776 201312-2900-023
Historical Active 201201-2900-003
VA 2900-0776 VBA-COMP-DB
Disability Benefits Questionnaires (Group 2)
Revision of a currently approved collection   No
Regular
Approved without change 11/24/2014
Retrieve Notice of Action (NOA) 09/19/2014
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved 11/30/2014
400,000 0 725,000
162,500 0 311,250
0 0 0

These forms are being created to assist veterans who require a disability examination in support of a claim for VA benefits. These forms will be used to record the findings of the examining physician.

US Code: 38 USC 501(a) Name of Law: null
  
None

Not associated with rulemaking

  79 FR 12 01/17/2014
79 FR 130 07/08/2014
No

  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 400,000 725,000 0 -325,000 0 0
Annual Time Burden (Hours) 162,500 311,250 0 -148,750 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Changing Forms
The respondent burden is decreased because VA removed nine collections from this group and rquested they be assigned individual OMB Control numbers.. With the exception of the expiration date placeholder, there are no substantive revisions to the remaining information collections..

$19,771,937
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.
09/19/2014


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