Income and Asset Statement in Support of Claim for Pension or Parents' Dependency and Indemnity Compensation (DIC) (VA Form 21P-0969)

ICR 201809-2900-003

OMB: 2900-0829

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
214403 Modified
ICR Details
2900-0829 201809-2900-003
Active 201412-2900-019
VA VBA-P&F-NK
Income and Asset Statement in Support of Claim for Pension or Parents' Dependency and Indemnity Compensation (DIC) (VA Form 21P-0969)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 10/23/2018
Retrieve Notice of Action (NOA) 09/18/2018
  Inventory as of this Action Requested Previously Approved
10/31/2021 36 Months From Approved
60,000 0 0
25,000 0 0
0 0 0

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 Determinations with respect to annual income • 38 U.S.C. § 1541 Surviving spouses of veterans of a period of war • 38 U.S.C. § 1543 Net worth limitation • 38 U.S.C. § 1315 Dependency and indemnity compensation to parents 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-0969 will be used by claimants for VA Pension or Parents' Dependency and Indemnity Compensation (DIC) to provide information pertaining to income and assets to establish entitlement to Pension or Parents' DIC. This form will be completed only by those claimants who had income other than Social Security benefits during the calendar year before claiming benefits or who disposed of assets or have significant assets which may affect their entitlement to needs-based benefits.

US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1543 Name of Law: Net worth limitation
   US Code: 38 USC 1503 Name of Law: Determinations with respect to annual income
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
  
None

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

No

  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 0 0 60,000 0 0
Annual Time Burden (Hours) 25,000 0 0 25,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
This form is being created to collect the information necessary to administer the Pension program after the rule is finalized.

$2,082,500
No
    Yes
    Yes
No
No
No
Uncollected
Nancy Kessinger 202 632-8924 nancy.kessinger@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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