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

Forms and Documents

Document Name	Status
Form 21P-8049 Request for Details of Expenses Form	Modified
2900-0138 30-Day FRN.pdf Supplementary Document	2016-06-07
2900-0138 60-Day FRN.pdf Supplementary Document	2016-03-30
2900-0138 Revisions Description.docx Supplementary Document	2016-03-17
2900-0138 Supporting Statement.docx Supporting Statement A	2016-05-31

IC Document Collections

IC ID	Document Title	Status
28360	Request for Details of Expenses Form	Modified

ICR Details

OMB Control No: 2900-0138	ICR Reference No: 201602-2900-004
Status: Historical Active	Previous ICR Reference No: 201304-2900-025
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YM
Title: Request for Details of Expenses (VA Form 21P-8049)
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: 09/09/2016
	Date Received in OIRA: 06/09/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved	11/30/2016
Responses	22,800	0	22,800
Time Burden (Hours)	5,700	0	5,700
Cost Burden (Dollars)	115,283	0	0

---

Abstract: 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.

---

Authorizing Statute(s): US Code: 38 USC 1522 Name of Law: Net Worth Limitation
  

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:
	81 FR 17245	03/28/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 36659	06/07/2016
Did the Agency receive public comments on this ICR? No

---

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

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

---

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	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

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:

---

Annual Cost to Federal Government: $1,040,136

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: 06/09/2016

---