Application for Refund of Educational Contributions (VA Form 22-5281)

Forms and Documents

Document Name	Status
Form VA Form 22-5281 Application for Refund of Educational Contributions Form	Modified
2019-26958.pdf Supplementary Document	2019-12-16
SUPPORTINGSTATE(2900-0261).docx Supporting Statement A	2019-10-23
2019-21931.pdf Supplementary Document	2019-10-23

IC Document Collections

IC ID	Document Title	Status
28505	Application for Refund of Educational Contributions Form	Modified

ICR Details

OMB Control No: 2900-0261	ICR Reference No: 201909-2900-008
Status: Active	Previous ICR Reference No: 201602-2900-030
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-NK
Title: Application for Refund of Educational Contributions (VA Form 22-5281)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/28/2020
	Date Received in OIRA: 01/16/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved	09/30/2020
Responses	67	0	461
Time Burden (Hours)	11	0	77
Cost Burden (Dollars)	0	0	0

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Abstract: The information submitted on VA Form 22-5281 is necessary in order to process the payment of refunds of contributions made by program participants who wish to dis enroll.

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Authorizing Statute(s): US Code: 38 USC 3223 Name of Law: Refunds of contributions upon disenrollment
   PL: Pub.L. 94 - 502 1623 Name of Law: Refunds of contributions upon disenrollment
   PL: Pub.L. 104 - 275 3018C Name of Law: Enrollment of certain VEAP participants in Montgomery GI Bill
  

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:
	84 FR 21931	10/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26958	12/16/2019
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
Application for Refund of Educational Contributions	VA Form 22-5281	Application for Refund of Educational Contributions

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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	67	461	0	-394	0	0
Annual Time Burden (Hours)	11	77	0	-66	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease is due to fewer program participants.

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Annual Cost to Federal Government: $156

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? No

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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: 01/16/2020

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