Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)

ICR 201811-2900-001

OMB: 2900-0747

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2019-04-19
Supplementary Document
2019-03-22
Supporting Statement A
2019-04-16
Supplementary Document
2018-11-20
IC Document Collections
ICR Details
2900-0747 201811-2900-001
Active 201711-2900-006
VA VBA-COMP-NK
Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)
Revision of a currently approved collection   No
Regular
Approved with change 09/16/2019
Retrieve Notice of Action (NOA) 05/15/2019
  Inventory as of this Action Requested Previously Approved
09/30/2022 36 Months From Approved 03/31/2021
1,360,000 0 34,813
498,667 0 14,505
0 0 0

Public Law 110-389, Section 221(a)directs the Department of Veterans Affairs (VA) to expeditiously process fully developed compensation and pension claims within 90 days after receipt of the claim. VA Form 21-526EZ is used to collect the information needed to process a fully developed claim for disability compensation and/or related compensation benefits. Though the law requires the claimant submit a certification in writing that states no additional information or evidence is available or needs to be submitted in order for the claim to be adjudicated via the fully developed claim program, the form has evolved into a standard claim form to be used for any benefit associated with disability compensation; to include new or initial claims, reopened claims, and claims for increase.

PL: Pub.L. 110 - 389 221 Name of Law: Veterans¿ Benefits Improvement Act of 2008
   US Code: 38 USC 5101 Name of Law: Claims and Forms
  
None

Not associated with rulemaking

  83 FR 25256 11/20/2018
84 FR 7106 04/10/2019
No

1
IC Title Form No. Form Name
Application for Disability Compensation and Related Compensation Benefits VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits

  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 1,360,000 34,813 0 1,325,187 0 0
Annual Time Burden (Hours) 498,667 14,505 0 484,162 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
VA Form 21-526EZ is being resubmitted to correct the previous estimate of burden. The publication of RIN 2900-AO81, Standard Claims and Appeals final rule on 9/24/2014, required submission of all claims on a standardized form, greatly increasing the total number of respondents. Unfortunately, the previous justification did not include updates to the increase in respondents and burden estimate. This resubmission corrects that error. Within the new burden estimate, VA has separated out the paper and electronic burdens for tracking/informational purposes as we move to continue improving our electronic claims process. VA increased the burden, due to: • New or initial claims received, • Reopened claims received, • Increased claims received, and • General program changes, such as regulatory changes and the discontinuance of other claim forms (if any). This new estimate of respondents has increased the burden estimate.

$59,253,538
No
    Yes
    Yes
No
No
No
Uncollected
Danny Green 202 421-1354 danny.green2@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.
05/15/2019


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