Dependent's Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) (VA Form 22-5495)

Forms and Documents

Document Name	Status
Form VA Form 22-5495 Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) Form	Modified
White Paper 22-5495.docx Justification for No Material/Nonsubstantive Change	2018-07-18
2900-0099SupportState.docx Supporting Statement A	2016-09-11

IC Document Collections

IC ID	Document Title	Status
28273	Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) Form	Modified

ICR Details

OMB Control No: 2900-0099	ICR Reference No: 201807-2900-006
Status: Historical Active	Previous ICR Reference No: 201509-2900-001
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-NK
Title: Dependent's Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.) (VA Form 22-5495)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/17/2018
	Date Received in OIRA: 08/27/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	09/30/2019	09/30/2019
Responses	144,333	0	144,333
Time Burden (Hours)	36,083	0	36,083
Cost Burden (Dollars)	0	0	0

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Abstract: Surviving spouses, spouses, and children of veterans send VA the VA Form 22-5495 to apply for a change of their program of education and/or a new place of training under 38 U.S.C. chapter 35. VA uses the information on the form to determine the current eligibility of the claimant for educational assistance for the new program of education or new place of training.

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Authorizing Statute(s): US Code: 38 USC 3034(a) Name of Law: Program Administration
   US Code: 38 USC 3323(a) Name of Law: Administration
   US Code: 38 USC 3521 Name of Law: Approval of Application
   US Code: 38 USC 3513 Name of Law: Application
   US Code: 38 USC 3691 Name of Law: Change of Program
  

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:
	80 FR 29723	11/23/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 3287	02/18/2016
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
Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapter 33 and 35, Title 38 U.S.C.)	VA Form 22-5495	Dependents' Request for Change of Program or Place of Training

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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	144,333	144,333	0	0	0	0
Annual Time Burden (Hours)	36,083	36,083	0	0	0	0
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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $929,859

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: 08/27/2018

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