Fiduciary Statement in Support of Appointment (21P-0792)

ICR 201704-2900-001

OMB: 2900-0670

Federal Form Document

IC Document Collections
ICR Details
2900-0670 201704-2900-001
Historical Active 201405-2900-017
VA VBA-P&F-YA
Fiduciary Statement in Support of Appointment (21P-0792)
Revision of a currently approved collection   No
Regular
Approved without change 12/08/2017
Retrieve Notice of Action (NOA) 09/22/2017
  Inventory as of this Action Requested Previously Approved
12/31/2020 36 Months From Approved 03/31/2018
43,000 0 7,500
10,750 0 1,875
0 0 0

VA Form 21P-0792 will be completed by individuals who are seeking to be appointed as fiduciaries of VA beneficiaries. The information will be used by VA field examiners to determine whether an individual is an appropriate fiduciary for a VA beneficiary and make an inquiry into his or her credit and criminal background.

US Code: 38 USC 5507 Name of Law: Inquiry, Investigations, and Qualifications of Fiduciaries
  
None

Not associated with rulemaking

  82 FR 27331 06/14/2017
82 FR 40063 08/23/2017
No

1
IC Title Form No. Form Name
Fiduciary Statement in Support of Appointment (21P-0792) 21P-792 Fiduciary Statement in Support of Appointment

  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 43,000 7,500 0 0 35,500 0
Annual Time Burden (Hours) 10,750 1,875 0 0 8,875 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This submission reports an increase of burden hours since the last submission. The increase in burden is based on an increase of beneficiary's requiring fiduciary services. Changes to the form include removing the Veteran/beneficiary social security number and changing the expiration date to be in standard with OMB. The expiration date placeholder has been added to the form.

$102,906
No
    Yes
    Yes
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.
09/22/2017


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