Request for Details of Expenses (VA Form 21P-8049)

ICR 201602-2900-004

OMB: 2900-0138

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2016-06-07
Supplementary Document
2016-03-30
Supplementary Document
2016-03-17
Supporting Statement A
2016-05-31
IC Document Collections
IC ID
Document
Title
Status
28360 Modified
ICR Details
2900-0138 201602-2900-004
Historical Active 201304-2900-025
VA VBA-P&F-YM
Request for Details of Expenses (VA Form 21P-8049)
Revision of a currently approved collection   No
Regular
Approved without change 09/09/2016
Retrieve Notice of Action (NOA) 06/09/2016
  Inventory as of this Action Requested Previously Approved
09/30/2019 36 Months From Approved 11/30/2016
22,800 0 22,800
5,700 0 5,700
115,283 0 0

VA uses the information collected on this form as evidence of additional circumstances which may affect entitlement determinations pursuant to 38 USC §1522. The information is used as a counterbalance to a claimant’s substantial estate and/or annual income.

US Code: 38 USC 1522 Name of Law: Net Worth Limitation
  
None

Not associated with rulemaking

  81 FR 17245 03/28/2016
81 FR 36659 06/07/2016
No

1
IC Title Form No. Form Name
Request for Details of Expenses 21P-8049 REQUEST FOR DETAILS OF EXPENSES

  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 22,800 22,800 0 0 0 0
Annual Time Burden (Hours) 5,700 5,700 0 0 0 0
Annual Cost Burden (Dollars) 115,283 0 0 115,283 0 0
No
No

$1,040,136
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@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.
06/09/2016


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