Statement of Person Claiming to Have Stood in Relation of Parent (VA Form 21P-524)

Forms and Documents

Document Name	Status
Form 21P-524 Statement of Person Claiming to Have Stood in Relation of Parent Form	Modified
30-Day FRN - 2900-0059 (2017).pdf Supplementary Document	2017-06-14
60-day FRN - 2900-0059 (2017).pdf Supplementary Document	2017-04-12
2900-0059 Supporting Statement.docx Supporting Statement A	2017-06-26

IC Document Collections

IC ID	Document Title	Status
28190	Statement of Person Claiming to Have Stood in Relation of Parent Form	Modified

ICR Details

OMB Control No: 2900-0059	ICR Reference No: 201610-2900-008
Status: Historical Active	Previous ICR Reference No: 201307-2900-010
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Statement of Person Claiming to Have Stood in Relation of Parent (VA Form 21P-524)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/08/2017
	Date Received in OIRA: 06/26/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	08/31/2017
Responses	400	0	400
Time Burden (Hours)	800	0	800
Cost Burden (Dollars)	16,180	0	0

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Abstract: VA Form 21P-524 is used to gather information from claimants seeking service-connected survivors benefits as persons who stood in relation of parent to deceased veterans. This relationship must be established in order to meet basic eligibility requirements.

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Authorizing Statute(s): US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 8562	01/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 27329	06/14/2017
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Statement of Person Claiming to Have Stood in Relation of Parent	21P-524	STATEMENT OF PERSON CLAIMING TO HAVE STOOD IN RELATION OF PARENT

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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	400	400	0	0	0	0
Annual Time Burden (Hours)	800	800	0	0	0	0
Annual Cost Burden (Dollars)	16,180	0	0	16,180	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:

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Annual Cost to Federal Government: $25,804

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

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Common Form ICR:  No

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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: 06/26/2017

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