Residency Verification Report-Veterans and Survivors (Form Letter 21-914)

ICR 202006-2900-005

OMB: 2900-0655

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2020-12-17
Supplementary Document
2020-06-23
Supporting Statement A
2020-06-23
IC Document Collections
IC ID
Document
Title
Status
28931 Modified
ICR Details
2900-0655 202006-2900-005
Received in OIRA 201610-2900-004
VA VBA-COMP-MS
Residency Verification Report-Veterans and Survivors (Form Letter 21-914)
Reinstatement without change of a previously approved collection   No
Regular 12/17/2020
  Requested Previously Approved
36 Months From Approved
1,250 0
417 0
613 0

Form Letter 21-914 gathers the information necessary to verify that a Filipino veteran or beneficiary who is receiving benefits at the full-dollar rate based on U.S. residency continues to meet the residency requirements. The proper rate of payment could not be determined without this information.

US Code: 38 USC 107 Name of Law: Certain service deemed not to be active service
  
None

Not associated with rulemaking

  85 FR 37157 06/19/2020
85 FR 61799 09/30/2020
No

1
IC Title Form No. Form Name
Residency Verification Report-Veterans and Survivors FL21-914 Residency Verification Report (RVR) - Veterans and Survivors

  Total Request 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 1,250 0 0 0 0 1,250
Annual Time Burden (Hours) 417 0 0 0 0 417
Annual Cost Burden (Dollars) 613 0 0 0 0 613
No
No

$32,724
No
    Yes
    Yes
No
No
No
No
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.
12/17/2020


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