Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) (VA Form 21P-535)

Forms and Documents

Document Name	Status
Form VA Form 21P-535 Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) Form	Modified
2900-0005SupportStatement (CR 1 6 15).doc Supporting Statement A	2015-01-09
VA Form 21P-535 Comment Response.docx Justification for No Material/Nonsubstantive Change	2014-12-29

IC Document Collections

IC ID	Document Title	Status
28078	Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) Form	Modified

ICR Details

OMB Control No: 2900-0005	ICR Reference No: 201412-2900-012
Status: Historical Active	Previous ICR Reference No: 201406-2900-053
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation) (VA Form 21P-535)
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: 03/20/2015
	Date Received in OIRA: 02/10/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	3,600	0	1,783
Time Burden (Hours)	4,320	0	2,140
Cost Burden (Dollars)	103,680	0	0

---

Abstract: VA Form 21P-535 is used by surviving parents to apply for Dependency and Indemnity Compensation (DIC), death compensation, and/or accrued benefits. This information collection allows VA to determine eligibility for this benefit.

---

Authorizing Statute(s): US Code: 38 USC 5121 Name of Law: Payment of certain accrued benefits upon death of a beneficiary
   US Code: 38 USC 501(a)(2) Name of Law: Rules and regulations
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 1121 Name of Law: Death Compensation - Basic entitlement
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 191	10/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 245	12/22/2014
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)	VA Form 21P-535	Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation when Applicable)

---

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	3,600	1,783	0	1,817	0	0
Annual Time Burden (Hours)	4,320	2,140	0	2,180	0	0
Annual Cost Burden (Dollars)	103,680	0	0	103,680	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The requested annual responses is increased to reflect an expected increase in the number of responses. The time burden for the form has not changed, the increase in annual burden hours is caused by the increase in responses. The Annual Cost Burden ($) was not previously calculated, that has been remedied with this submission.

---

Annual Cost to Federal Government: $405,506

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

---

Common Form ICR:  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:

(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: 02/10/2015

---