Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet (21-0773)

ICR 201406-2900-013

OMB: 2900-0720

Federal Form Document

ICR Details
2900-0720 201406-2900-013
Historical Active 201107-2900-022
VA 2900-0720 VBA-COMP-NK
Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet (21-0773)
Revision of a currently approved collection   No
Regular
Approved without change 03/20/2015
Retrieve Notice of Action (NOA) 01/05/2015
  Inventory as of this Action Requested Previously Approved
03/31/2018 36 Months From Approved 03/31/2015
14,000 0 14,000
7,000 0 7,000
0 0 0

The VA Form 21-0773 will serve as a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness.

US Code: 5 USC 552a Name of Law: Records maintained on individuals
  
None

Not associated with rulemaking

  79 FR 168 08/29/2014
79 FR 245 12/22/2014
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 14,000 14,000 0 0 0 0
Annual Time Burden (Hours) 7,000 7,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$481,184
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.
01/05/2015


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