Veteran's Application for C&P, Veteran's Supplemental Claim Application, General Release for Med Provider Info to the Dept of VA, Authorization to Disclose Info to the Dept of VA

ICR 201407-2900-015

OMB: 2900-0001

Federal Form Document

ICR Details
2900-0001 201407-2900-015
Historical Active 201403-2900-010
VA 2900-0001 VBA-COMP-NK
Veteran's Application for C&P, Veteran's Supplemental Claim Application, General Release for Med Provider Info to the Dept of VA, Authorization to Disclose Info to the Dept of VA
Revision of a currently approved collection   Yes
Regular
Approved without change 08/26/2014
Retrieve Notice of Action (NOA) 07/30/2014
  Inventory as of this Action Requested Previously Approved
08/31/2017 36 Months From Approved 06/30/2017
433,433 0 724,108
149,182 0 452,740
0 0 0

VA Forms 21-526 and 21-526b are used to gather the necessary information to determine a veteran's eligibility, dependency, and income, as applicable, for the compensation and/or pension benefit sought. Without this information, determination of entitlement would not be possible. VA Form 21-4142, is used to authorize the disclosure of information to the Department of Veterans Affairs (VA). VA Form 21-4142a, is used to gather private provider information from the claimant to the VA.

US Code: 38 USC Section 5101(a) Name of Law: Claims and forms
  
None

2900-AO81 Final or interim final rulemaking 78 FR 211 10/31/2013

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 433,433 724,108 0 -290,675 0 0
Annual Time Burden (Hours) 149,182 452,740 0 -303,558 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The decrease in burden is due to the Final Rule RIN 2900-AO81, Standard Claims and Appeals Forms which requires all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is codifying its regulations to standardize the use of all VA forms, to include VA Forms 21-526 and 21-526b.

$4,188,575
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@va.gov

  Yes
 
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title

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.
07/30/2014


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