Veteran's Supplemental Claim Application (VA Form 21-526b)

Forms and Documents

Document Name	Status
Form VA Form 21-526b Veteran's Supplemental Claim Application (VA Form 21-526b) Form	Modified
2900-0001, Supporting Statement (VAF 21-526b).docx Supporting Statement A	2018-04-12
2017-19987, 30-Day FRN (21-526b).pdf Supplementary Document	2017-12-07
2017-13008, 60-Day FRN (21-526, 526b).pdf Supplementary Document	2017-12-07

IC Document Collections

IC ID	Document Title	Status
28062	Veteran's Supplemental Claim Application (VA Form 21-526b) Form	Modified

ICR Details

OMB Control No: 2900-0001	ICR Reference No: 201712-2900-005
Status: Historical Inactive	Previous ICR Reference No: 201407-2900-015
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-NK
Title: Veteran's Supplemental Claim Application (VA Form 21-526b)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 06/25/2018
	Date Received in OIRA: 04/16/2018
Terms of Clearance: This is being returned because it was submitted as a "Request for Common Form" but it is not a common form. The agency may resubmit it as a reinstatement.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved
Responses	433,433	0	0
Time Burden (Hours)	149,182	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-526b is used to gather the necessary information to determine a veteran's eligibility, dependency, and income, as applicable, for the compensation and/or pension benefit sought. Without this information, determination of entitlement would not be possible.

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Authorizing Statute(s): US Code: 38 USC Section 5101(a) Name of Law: Claims and forms
  

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 28546	06/22/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 44028	09/20/2017
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
Veteran's Supplemental Claim Application (VA Form 21-526b)	VA Form 21-526b	Veterans Supplemental Claim Application

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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: The decrease in burden for this control number is because it previously contained four forms. VA Forms 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, have been separated from this control number. A new control number has been assigned for these forms. VA Form 21-526, Veterans Application for Compensation and/or Pension, has been removed due to agency discretion. This form will be discontinued.

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Annual Cost to Federal Government: $11,923,796

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:  Yes

Description/Changes for Common Form Usage:  VA Forms 21-526b is being revised to include new standardization data points; to include optical character recognition boxes. This is a non-substantive change. The contention questions in Section II of VA Form 21-526b has been revised to match other application forms to stay consistent. Note: This control number previously contained four forms. VA Forms 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, have been separated from this control number. A new control number has been assigned to these forms. VA Form 21-526, Veterans Application for Compensation and/or Pension, has been removed due to agency discretion. This form will be discontinued.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 04/16/2018

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