Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)

Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors) (VA Form 21P-8924)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0390 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21P-8924 Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors) Form
VA Form 21P-8924 Application of Surviving Spouse or Child for REPS Benefi 21P-8924(12-17).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)	Agency IC Tracking Number:	2900-0390

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.812

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21P-8924	Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement for Survivors)	21P-8924(12-17).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 77 FR 42593

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,800	0	1,800
Annual IC Time Burden (Hours)	600	0	600
Annual IC Cost Burden (Dollars)	14,316	14,316	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.