VA
Form 21P-0847
OMB 2900-0740
The Department of Veterans Affairs (VA), through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services established by law for veterans, service personnel, and their dependents and/or beneficiaries. Information requested by this form is authorized under the authority of 38 U.S.C. §5121(a), Payment of Certain Accrued Benefits Upon Death of a Beneficiary.
VA Form 21P-0847, Application for Request to Substitute Claimant, will be used to allow claimants to request substitution for a claimant who passed away prior to VA processing a claim to completion. This is only allowed when a claimant dies while a claim or appeal for any benefit under a law administered by the VA is pending. The substitute claimant would be eligible to receive accrued benefits due a deceased claimant under Section 5121(a). The substitute claim must be filed no later than one year after the date of the death of the claimant. By law, VA must have a claimant’s or beneficiary’s written permission (an "authorization") to be a substitute claimant. The claimant or beneficiary may revoke the authorization at any time, except if VA has already acted based on the permission.
VA Form 21P-0847 is available on the VA web site in a fillable electronic format. The collection of information does not involve automated, electrical, mechanical, or other technological techniques.
Program reviews were conducted to identify potential areas of duplication; however, none were found to exist. There is no known Department or Agency which maintains the necessary information, nor is it available from other sources within our department.
The collection of information does not involve small businesses or entities.
If this collection is not conducted, VBA will not be able to administer claims for Substitution of Claimant. The information is collected on an ad hoc basis, and, therefore, cannot be collected less frequently. The form is designed to collect the minimum amount of information which will allow VBA to properly administer the program.
There are no special circumstances which would cause this information collection to be conducted more often than quarterly, or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by Office of Management and Budget.
The Department notice was published in the Federal Register on June 27, 2018, Volume 83, No. 124, pages 30226 and 30227. No comments were received in response to this notice.
VA did not solicit input from external sources regarding this information collection.
No payments or gifts to respondents have been made under this collection of information.
The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 (June 19, 2009).
There are no questions of a sensitive nature.
Number of Annual Respondents: 20,000
Frequency of Response: One-time
Total Burden Hours: 1,667 hours
Estimated Completion Time: 5.00 minutes (0.083333 hours)
Any
person may apply for one of the benefits covered by this collection.
Therefore, it is not possible to make assumptions regarding the
population of claimants and appellants, such as the average age of
claimants or their average earnings. In order to estimate the costs
to respondents, VBA used general wage information for the population
as a whole.
The Bureau of Labor Statistics (BLS) gathers
information on full-time wage and salary workers. According to
the latest available BLS data, the median weekly earnings of
full-time wage and salary workers are $973.60. Assuming a
forty (40) hour work week, the mean hourly wage is $24.34 based on
the BLS wage code – “00-0000 All Occupations.”
This information was taken from the following
website: (https://www.bls.gov/oes/current/oes_nat.htm,
May 2017).
Legally, respondents may not pay a person or
business for assistance in completing the information collection,
and a person or business may not accept payment for assisting a
respondent in completing the information collection. Therefore,
there are no expected overhead costs for completing the information
collection. VBA estimates the total cost of all respondents to be
$40,567.00 (1,667 burden hours x $24.34 per hour).
Median
Weekly Wage = $973.60/week
Median Hour Wage = $954.40/week x
40hrs/week = $24.34/hr.
Burden Hours per Response = 0.083333
hrs.
Cost per Response = $24.34/hr. x 0. 083333 hrs. =
$2.0283333
Total Burden Estimate = $2.0283333/Response x 20,000
Responses = $40,567.00
This submission does not involve any record-keeping costs.
Grade |
Step |
Burden Time |
Fraction of Hour |
Hourly Rate |
Cost Per Response |
Total Responses |
Total |
5 |
3 |
15 Min. |
0.25 |
$14.79 |
$3.6975 |
20,000 |
$73,950.00 |
Overhead at 100% Salary |
$73,950.00 |
||||||
9 |
3 |
15 Min. |
0.25 |
$22.42 |
$5.6050 |
20,000 |
$112,100.00 |
Overhead at 100% Salary |
$112,100.00 |
||||||
11 |
3 |
15 Min. |
0.25 |
$27.12 |
$6.7800 |
20,000 |
$135,600.00 |
Overhead at 100% Salary |
$135,600.00 |
||||||
|
|
||||||
Processing / Analyzing Costs |
$643,300.00 |
||||||
Printing and Production Cost |
$0.00 |
||||||
Total Cost to Government |
$643,300.00 |
Note:
The hourly wage information above is based on the hourly 2018 General
Schedule (Base) Pay
(https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/GS_h.pdf).
This rate does not include any locality adjustment as applicable.
The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.
To account for overhead costs and benefits, we factored in additional costs of 100% of employee salary. This is necessarily a rough adjustment, because methods of estimating these costs vary widely from study to study. One such study, from the Boston Business Journal (http://web.mit.edu/e-club/hadzima/pdf/how-much-does-an-employee-cost.pdf), references an estimate of overhead costs and benefits as high of 170% of employee salary. Since there is no industry standard for estimating overhead costs and benefits costs based on employee salary, we feel our estimate of 100% of employee salary is reasonable.
The respondent burden hours per response has not changed (5 minutes or 0.08333 hours).
The annual Cost Burden ($) for this submission is reduced by $1,100 due to updated wage data used during the calculation, as detailed in Item 12 of this statement.
The information collection is not for publication or tabulation use.
VA will display the expiration date.
There are no exceptions.
No statistical methods are used in this data collection.
Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | SUPPORTING STATEMENT FOR VA FORM 10-2065, FUNERAL ARRANGEMENTS; VA FORM 10-10, APPLICATION FOR MEDICAL BENEFITS; VA FORM 10-10I, |
Author | Preferred Customer |
File Modified | 0000-00-00 |
File Created | 2021-01-20 |