Application for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery

Forms and Documents

Document Name	Status
Form VA40-1330 Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery Form and Instruction	Modified
VA40-1330M 10 2017.pdf Supplementary Document	2017-10-03
VA40-1330(Draft 10-2017).pdf Supplementary Document	2017-10-03
OMB Justification for 1330 Redesign Project Rev 3 2017 8-21 CLEAN.docx Supporting Statement A	2017-09-28
30-day FRN 2900-0222.pdf Supplementary Document	2017-06-21

IC Document Collections

IC ID	Document Title	Status
28470	Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0222	ICR Reference No: 201703-2900-016
Status: Historical Active	Previous ICR Reference No: 201304-2900-020
Agency/Subagency: VA	Agency Tracking No: 2900-0222
Title: Application for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/13/2017
	Date Received in OIRA: 10/05/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved
Responses	166,135	0	0
Time Burden (Hours)	41,534	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 40-1330 is used by the public to apply for Government-provided headstones or markers for unmarked graves of eligible veterans in accordance with 38 USC 2306. It is the source of information used to evaluate the applicant’s claim for the benefit. The information is requested under 38 CFR 38.632 and represents the minimum requirement by VA to properly determine the veteran’s eligibility for, and entitlement to, this benefit. VA Form 40-1330M is used by the public to apply for Government-provided medallions to be affixed to privately purchased headstones or markers of veterans that died on or after November 1, 1990. It is the source of information used to evaluate the applicant’s claim for the benefit. The information is requested under 38 CFR 38.632 and represents the minimum requirement by VA to properly determine the veteran’s eligibility for, and entitlement to, this benefit.

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Authorizing Statute(s): US Code: 38 USC Section 2306 Name of Law: Headstones, markers, and burial receptacles
   PL: Pub.L. 110 - 157 201 Name of Law: . James Allen Veteran Vision Equity Act of 2007
   US Code: 38 USC Section 2411 Name of Law: The Dignified Burial and Other Veterans' Benefits Improvement Act of 2012
   PL: Pub.L. 107 - 103 501 and 502 Name of Law: Government Markers for Marked Graves at Private Cemeteries
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 157 201 Name of Law: Blinded Veterans Paired Organs Act of 2007

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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 17740	04/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 27549	06/15/2017
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
Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery	VA 40-1330M, VA40-1330	Claim For Standard Government Headstone or Marker ,   Claim For Government Medallion For Placement in a Private Cemetery

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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	166,135	0	0	-188,438	0	354,573
Annual Time Burden (Hours)	41,534	0	0	-47,109	0	88,643
Annual Cost Burden (Dollars)	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a Reinstatement Request: The National Cemetery Administration (NCA) updated its current VA Form 40-1330 and VA Form 40-1330M. The original VA Form 40-1330 and 40-1330M is a request for a Government-furnished headstone or marker, or medallion, respectively. The updates to the form include the following: • Change to the Applicant Definition, who can apply for a Government headstone, marker or medallion; • Information about the Presidential Memorial Certificate (PMC) program and the option to receive a PMC in addition to the headstone, marker or medallion; • Changes in eligibility for a medallion, consistent with section 301 of Public Law 114-315; • Addition of language that clarifies that “mandatory” and “optional” inscription items are provided in English, and that “additional” inscription items may be provided in English or non-English text that consists of the Latin Alphabet or numbers; • Addition of information on VA Form 40-1330 and VA Form 40-1330M related to whether the Veteran was previously determined by VA to be eligible for burial, and related to whether the request is initial or for a replacement headstone or marker; • Addition of “Iraq” and “Afghanistan” as indicators of “War Service,” consistent with Public Law 114-315; • Addition of Age at the Time of Death on VA Form 40-1330 and VA Form 40-1330M; and • Addition of demographic information for statistical reporting purposes only on VA Form 40-1330 and VA Form 40-1330M.

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Annual Cost to Federal Government: $428,558

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 10/05/2017

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