Eligibility Verification Reports (EVRs)

ICR 201404-2900-008

OMB: 2900-0101

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
28278 Modified
ICR Details
2900-0101 201404-2900-008
Historical Active 201104-2900-029
VA 2900-0101 VBA-P&F-NK
Eligibility Verification Reports (EVRs)
Revision of a currently approved collection   No
Regular
Approved without change 04/10/2015
Retrieve Notice of Action (NOA) 01/23/2015
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
219,000 0 219,000
113,075 0 113,075
2,713,800 0 0

The EVR forms are used to determine and verify entitlement to income-based VA benefits. The forms are tailored for the specific classes of beneficiaries of each benefit program and request information about income, net worth, dependency status and other entitlement factors. Without this information, VA would be unable to properly pay benefits.

US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
  
None

Not associated with rulemaking

  79 FR 191 10/02/2014
79 FR 247 12/24/2014
No

1
IC Title Form No. Form Name
Eligibility Verification Reports VA Form 21P-0519S-1(Spanish), VA Form 21P-0510(Spanish), VA Form 21P-0512S-1, VA Form 21P-0512S-1 (Spanish), VA Form 21P-0510, VA Form 21P-0512V-1, VA Form 21P-0513-1 (Spanish), VA Form 21P-0513-1, VA Form 21P-0514-1, VA Form 21P-0514-1 (Spanish), VA Form 21P-0516-1, VA Form 21P-0516-1 (Spanish), VA Form 21P-0517-1, VA Form 21P-0517-1 (Spanish), VA Form 21P-0518-1, VA Form 21P-0518-1 (Spanish), VA Form 21P-0519C-1, VA Form 21P-0519C-1 (Spanish), VA Form 21P-0519S-1 Eligibility Verification Report Instructions ,   Eligibility Verification Report Instructions (Spanish) ,   Old Law and Section 306 Eligibility Verification Report (Surviving Spouse) ,   Old Law and Section 306 Eligibility Verification Report (Surviving Spouse) ,   Old Law Section 306 Eligibility Verification Report (Veteran) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) (Spanish) ,   DIC Parent's Eligibility Verification Report ,   DIC Parent's Eligibility Verification Report (Spanish) ,   Improved Pension Eligibility Verification Report ,   Improved Pension Eligibility Verification Report (Veteran with No Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Veteran with Children) ,   Improved Pension Eligibility Verification Report (Veteran with Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with No Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with No Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Child or Children) ,   Improved Pension Eligibility Verification Report (Child or Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with Children)

  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 219,000 219,000 0 0 0 0
Annual Time Burden (Hours) 113,075 113,075 0 0 0 0
Annual Cost Burden (Dollars) 2,713,800 0 0 2,713,800 0 0
No
No

$3,553,822
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.
01/23/2015


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