2900-0495 Supporting Statement_final

Marital Status Questionnaire (VA Form 21P-0537)
OMB 2900-0495

A. JUSTIFICATION

1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.

The Department of Veterans Affairs (VA), through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services established by law for Veterans, service personnel, and their dependents and/or beneficiaries. VA Form 21P-0537 Marital Status Questionnaire is used to confirm the marital status of a surviving spouse in receipt of Dependency and Indemnity Compensation (DIC) benefits. If a surviving spouse remarries, he or she is no longer entitled to DIC unless the marriage began after age 57 or has been terminated. Information is requested by this form under the authority of 38 U.S.C. 101(3) and 38 U.S.C. 103.

Responsibility for maintaining this information collection was transferred within VBA to Pension and Fiduciary Service. Accordingly, the VA Form number was updated to VA Form 21P-0537.

2. Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.

VA Form 21P-0537 is used to verify a surviving spouse’s current marital status to determine his or her continuing entitlement to DIC benefits. The form letter is automatically generated and mailed to DIC beneficiaries. Agency action depends on the information provided by the beneficiary. If the information provided supports the beneficiary’s continued entitlement to benefits, no action is taken. If the information provided by the beneficiary does not support continued entitlement to benefits, VA will take action to terminate benefit payments, based on the facts found.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

For the information collected on VA Form 21P-0537, VBA does not use automated, electronic, mechanical, or other technological collection techniques. VBA requires signed documentation certifying a beneficiary’s continued eligibility to benefits. Therefore, VA does not accept this information over the telephone.

Since VA Form 21P-0537 is generated and mailed via an automated process, the form is not available to the public in an electronic version.

VBA does not currently have the technology in place to allow for the electronic submission of the information collected on the form.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

VBA conducted program reviews to identify duplication, but found none. There is no known Department or Agency which maintains the necessary information, nor is the information available through other sources within VA.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

The collection of information does not affect small businesses or other small entities.

6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.

If this collection is not conducted, VA will have no way of evaluating the ongoing eligibility of surviving spouses to DIC benefits. This situation would damage the integrity of the program and increase the likelihood of improper payments of benefits.

DIC beneficiaries under age 57 may be selected for this collection no more than once every eight (8) years. Less frequent collection of this information would damage the integrity of the program and increase the likelihood of improper payments of benefits.

7. Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.

There are no special circumstances which would cause this information collection to be conducted more often than quarterly, or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.

8. a. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.

The sponsor’s notice was published in the Federal Register on Friday, March 25, 2016 (81 FR 16283), soliciting comments on the information collection. VA did not receive any comments in response to the notice.

b. Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, clarity of instructions and recordkeeping, disclosure or reporting format, and on the data elements to be recorded, disclosed or reported. Explain any circumstances which preclude consultation every three years with representatives of those from whom information is to be obtained.

VA did not consult with those from whom the information is to be obtained.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No payments or gifts to respondents will be made under this collection of information.

10. Describe any assurance of privacy to the extent permitted by law provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 (June 19, 2009).

11. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

12. Estimate of the hour burden of the collection of information:

1. Number of Annual Respondents: 17,808
   This data was mined from VBA’s claims database.

2. Frequency of Response: One-time.

3. Estimated Completion Time: 5.00 minutes (0.0833 hours)

4. Total Burden Hours: 1,484 hours

5. The respondent population is composed of the surviving spouses of deceased Veterans. VBA does not require surviving spouses who are age 57 or older to respond to this collection, so the respondent population is composed entirely of working-age adults. VBA cannot make further assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA used general wage data to estimate the respondents’ costs associated with completing the information collection.
   
   The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers. According to the latest available BLS Current Population Survey (CPS) (http://www.bls.gov/cps/cpsaat39.htm) (dated February 10, 2016), the median weekly earnings of full-time wage and salary workers are $809.00. Assuming a forty (40) hour work week, the median hourly wage is $20.23.
   
   Legally, respondents may not pay a person or business for assistance in completing the information collection, and a person or business may not accept payment for assisting a respondent in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost of all respondents to be $$30,013.90.
   
   Median Weekly Wage = $809.00/week
   Median Hour Wage = $809.00/week % 40hrs/week = $20.225/hr
   Burden Hours per Response = 5 mins = 1/12 hrs
   Cost per Response = $20.225/hr % 1/12 hrs = $1.68583
   Total Burden Estimate = $1. 68583/Response x 17,808 Responses = $30,013.90

13. Provide an estimate of the total annual cost burden to respondents or record-keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

The submission does not involve any record-keeping costs.

14. Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

Total Processing/Analyzing Costs with Overhead $52,000.00

• GS-5/3 @ $17.52 x 17,808 x 0.0833 hours = $26,000.00

• GS-5/3 Overhead at 100% of Salary- $26,000.00

Printing and production and mailing cost ($590/thousand) $10,507.00

Total cost to government $62,507.00

Note: the hourly wage information above is based on the 2016 hourly wages for employees of the VA Regional Office at St. Paul, Minnesota (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2016/MSP_h.pdf). The St. Paul Regional Office is one of three adjudication offices which process these types of claims (Milwaukee and Philadelphia are the others). The locality adjustment of 21.3% applicable to St. Paul falls between the locality adjustments of Milwaukee and Philadelphia.

The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.

To account for overhead costs and benefits, we factored in additional costs of 100% of employee salary. This is necessarily a rough adjustment, because methods of estimating these costs vary widely from study to study. One such study, from the Boston Business Journal (http://web.mit.edu/e-club/hadzima/pdf/how-much-does-an-employee-cost.pdf), references an estimate of overhead costs and benefits as high of 170% of employee salary. Since there is no industry standard for estimating overhead costs and benefits costs based on employee salary, we feel our estimate of 100% of employee salary is reasonable.

15. Explain the reason for any burden hour changes since the last submission.

VBA re-estimated the annual number of respondents based on real claim data contained in our benefits database. The estimated completion time of five (5) minutes has not increased since the last submission.

This collection’s OMB expiration date has been added to the form.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

The information collected is not for tabulation.

17. If seeking approval to omit the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

We are not seeking to omit the expiration date.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.

This submission does not include any exceptions to the certification statement.

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

No statistical methods are used in this data collection.

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