Statement of Disappearance (VA Form 21P-1775)

ICR 201604-2900-005

OMB: 2900-0036

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2016-08-01
Supplementary Document
2016-05-11
Supporting Statement A
2016-07-13
IC Document Collections
IC ID
Document
Title
Status
28145 Modified
ICR Details
2900-0036 201604-2900-005
Historical Active 201602-2900-043
VA VBA-P&F-YM
Statement of Disappearance (VA Form 21P-1775)
Extension without change of a currently approved collection   No
Regular
Approved without change 11/04/2016
Retrieve Notice of Action (NOA) 08/03/2016
  Inventory as of this Action Requested Previously Approved
11/30/2019 36 Months From Approved 11/30/2016
10 0 10
28 0 28
566 0 566

Since no state law providing presumption of death is applicable to VA benefits, VA Form 21P-1775 is needed to gather sufficient information from a claimant so a formal decision can be made regarding the unexplained absence of an individual for over 7 years.

US Code: 38 USC 108 Name of Law: presumption of death
  
None

Not associated with rulemaking

  81 FR 29332 05/11/2016
81 FR 50603 08/01/2016
No

1
IC Title Form No. Form Name
Statement of Disappearance 21P-1775 Statement of Disappearance

  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 10 10 0 0 0 0
Annual Time Burden (Hours) 28 28 0 0 0 0
Annual Cost Burden (Dollars) 566 566 0 0 0 0
No
No

$484
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.
08/03/2016


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