Report of General Info., Death of Veteran/Beneficiary, Nursing Home Info., Defense Finance & Accounting Service, Lost Check, Incarceration, & Month of Death Check (27-0820, a, b, c, d, e, & f)

Forms and Documents

Document Name	Status
Form 27-0820a Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check Form	Modified
2900-0734SupportingState(9-8-15).doc Supporting Statement A	2015-09-08
30-Day FRN (2900-0734)(7-24-15).pdf Supplementary Document	2015-07-28

IC Document Collections

IC ID	Document Title	Status
187592	Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check Form	Modified

ICR Details

OMB Control No: 2900-0734	ICR Reference No: 201411-2900-005
Status: Historical Active	Previous ICR Reference No: 201203-2900-019
Agency/Subagency: VA	Agency Tracking No: 2900-0734 VBA-BAS-NK
Title: Report of General Info., Death of Veteran/Beneficiary, Nursing Home Info., Defense Finance & Accounting Service, Lost Check, Incarceration, & Month of Death Check (27-0820, a, b, c, d, e, & f)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/28/2015
	Date Received in OIRA: 08/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved	09/30/2015
Responses	2,550,000	0	2,550,000
Time Burden (Hours)	212,500	0	212,500
Cost Burden (Dollars)	0	0	0

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Abstract: These forms will be used by VA Regional Office and Pension Maintenance Center employees to meet our requirement to document verbal evidence obtained telephonically from our beneficiary or claimant that will be used as part of the evidence for a claim for benefits.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19	01/29/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 142	07/24/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Report of General Info., Rpt of Death of Veteran/Beneficiary, Rpt of Nursing Home Info., Rpt of Defense Finance & Accounting Service, Rpt of Lost Check, Report of Incarceration, Month of Death Check	27-0820c, 27-0820e, 27-0820a, 27-0820d, 27-0820f, VA Form 27-0820	Report of First Notice of Death ,   Report of Defense Finance and Accounting Service (DFAS) ,   Report of Non-Receipt of Payment ,   Report of Incarceration ,   Report of Month of Death ,   Report of General Information

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ICR Summary of Burden

	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	2,550,000	2,550,000	0	0	0	0
Annual Time Burden (Hours)	212,500	212,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $62,916,875

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/18/2015

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