Eligibility Verification Reports (EVRs)

Forms and Documents

Document Name	Status
Form VA Form 21P-0510 ( Eligibility Verification Reports Form	Modified
2021-12539.pdf Supplementary Document	2021-06-16
SupportStatement(2900-0101).docx Supporting Statement A	2021-06-14
2021-07268.pdf Supplementary Document	2021-04-12

IC Document Collections

IC ID	Document Title	Status
28278	Eligibility Verification Reports Form	Modified

ICR Details

OMB Control No: 2900-0101	ICR Reference No: 202102-2900-010
Status: Received in OIRA	Previous ICR Reference No: 201708-2900-012
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Eligibility Verification Reports (EVRs)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/16/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2021
Responses	69,000	69,000
Time Burden (Hours)	34,500	34,500
Cost Burden (Dollars)	0	0

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Abstract: The EVR forms are used to determine and verify entitlement to income-based VA benefits. The forms are tailored for the specific classes of beneficiaries of each benefit program and request information about income, net worth, dependency status and other entitlement factors. Without this information, VA would be unable to properly pay benefits.

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Authorizing Statute(s): US Code: 38 USC 1506 Name of Law: Resource reports and overpayment adjustments
  

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:
	86 FR 7268	04/09/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 12539	06/15/2021
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
Eligibility Verification Reports	VA Form 21P-0518-1, VA Form 21P-0518-1 (Spanish), VA Form 21P-0519C-1, VA Form 21P-0519C-1 (Spanish), VA Form 21P-0519S-1, VA Form 21P-0519S-1 (Spanish), VA Form 21P-0514-1 (Spanish), VA Form 21P-0510, VA Form 21P-0510 (Spanish), VA Form 21P-0519S-1 (Spanish), VA Form 21P-0512S-1, VA Form 21P-0512V-1, VA Form 21P-0513-1 (Spanish), VA Form 21P-0514-1, VA Form 21P-0513-1, VA Form 21P-0516-1, VA Form 21P-0516-1 (Spanish), VA Form 21P-0517-1, VA Form 21P-0517-1 (Spanish)	Eligibility Verification Report (Spanish) ,   Old Law Section 306 Eligibility Verification Report (Surviving Spouse) ,   Old Law Section 306 Eligibility Verification Report (Surviving Spouse) (Spanish) ,   Old Law and Section 306 Eligibility Verification Report (Veteran) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) ,   Old Law and Section 306 Eligibility Verification Report (Children Only) (Spanish) ,   DIC Eligibility Verification Report ,   DIC Eligibility Verification Report (Spanish) ,   Improved Pension Eligibility Verification Report (Veteran with No Children) ,   Improved Pension Eligibility Verification Report (Veteran with No Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Veteran with Children) ,   Improved Pension Eligibility Verification Report (Veteran with Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with No Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with No Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Child or Children) ,   Improved Pension Eligibility Verification Report (Child or Children) (Spanish) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with Children) ,   Improved Pension Eligibility Verification Report (Surviving Spouse with Children) ,   Eligibility Verification Report

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ICR Summary of Burden

	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	69,000	69,000	0	0	0	0
Annual Time Burden (Hours)	34,500	34,500	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,877,875

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: 06/16/2021

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