Medical Expense Report (VA Form 21P-8416)

ICR 201809-2900-002

OMB: 2900-0161

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2018-10-30
IC Document Collections
IC ID
Document
Title
Status
28397 Modified
ICR Details
2900-0161 201809-2900-002
Active 201604-2900-020
VA VBA-P&F-NK
Medical Expense Report (VA Form 21P-8416)
Revision of a currently approved collection   No
Regular
Approved with change 10/31/2018
Retrieve Notice of Action (NOA) 09/18/2018
  Inventory as of this Action Requested Previously Approved
10/31/2021 36 Months From Approved 01/31/2020
60,000 0 96,400
30,000 0 48,200
0 0 974,845

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 is requested by this form under the authority of 38 U.S.C. §1503(a)(8) regarding exceptions to countable income for needs-based benefits, specifically an amount equal to amounts paid by a claimant or beneficiary for unreimbursed medical expenses. In RIN 2900-AO73, VA proposes to amend its pension regulations to maintain the integrity of its needs-based pension program. VA has authority under 38 U.S.C. 501(a) to prescribe all rules and regulations which are necessary or appropriate to carry out the laws administered by VA. VA would amend its information collections in conjunction with RIN 2900-AO73. This rulemaking is largely in response to a Government Accountability Office (GAO) report, GAO-12-50, Veterans’ Pension Benefits: Improvements Needed to Ensure Only Qualified Veterans and Survivors Receive Benefits. VA Form 21P-8416 is used by claimants and beneficiaries to report unreimbursed medical expenses for the purpose of reducing their countable income associated with needs-based benefit programs such as VA Pension and Parents’ Dependency and Indemnity Compensation (DIC). Unreimbursed medical expenses are deducted from otherwise countable income to determine eligibility for income-based benefits and the rate payable.

US Code: 38 USC 1503(a)(8) Name of Law: Determinations with respect to annual income
  
None

2900-AO73 Final or interim final rulemaking 83 FR 47246 09/18/2018

No

1
IC Title Form No. Form Name
Medical Expense Report 21P-8416 Medical Expense Report

  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 60,000 96,400 0 -36,400 0 0
Annual Time Burden (Hours) 30,000 48,200 0 -18,200 0 0
Annual Cost Burden (Dollars) 0 974,845 0 -974,845 0 0
No
Yes
Miscellaneous Actions
The reduction in the number of estimated annual respondents was published in the Notice of Proposed Rulemaking 2900-AO73 (80 FR 3839 through 386, on January 23, 2015).

$3,351,400
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.
09/18/2018


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