Decision Review Request: Supplemental Claim (VA Form 20-0995)

ICR 202208-2900-007

OMB: 2900-0886

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2022-08-18
Supplementary Document
2021-02-22
Supplementary Document
2020-12-14
Supporting Statement A
2021-02-10
IC Document Collections
ICR Details
2900-0886 202208-2900-007
Active 202011-2900-001
VA VBA-OAR-YA
Decision Review Request: Supplemental Claim (VA Form 20-0995)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/19/2022
Retrieve Notice of Action (NOA) 08/19/2022
  Inventory as of this Action Requested Previously Approved
04/30/2024 04/30/2024 04/30/2024
265,000 0 265,000
66,250 0 66,250
0 0 0

VA Form 20-0995, Decision Review Request: Supplemental Claim, will be used by a claimant and/or beneficiary to formally request a review of an initial VA decision, based on new and relevant evidence, in accordance with the Appeals Modernization Act. The information collected will be used by VA to identify the issues in dispute which the claimant seeks review of in the Supplemental Claim Lane.

PL: Pub.L. 115 - 55 2 Name of Law: Veterans Appeals Improvement and Modernization Act of 2017
   US Code: 38 USC 5108 Name of Law: Supplemental Claims
  
None

Not associated with rulemaking

  85 FR 80895 12/14/2020
86 FR 10168 02/18/2021
No

1
IC Title Form No. Form Name
Decision Review Request: Supplemental Claim (VA Form 20-0995) 20-0995 Decision Review Request: Supplemental Claim

  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 265,000 265,000 0 0 0 0
Annual Time Burden (Hours) 66,250 66,250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$15,288,910
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 maribel.aponte@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.
08/19/2022


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