FIDUCIARY AGREEMENT

ICR 198209-2900-042

OMB: 2900-0319

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
174649 Migrated
ICR Details
2900-0319 198209-2900-042
Historical Active 198106-2900-010
VA
FIDUCIARY AGREEMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/08/1982
Approved with change 09/08/1982
Retrieve Notice of Action (NOA) 09/08/1982
  Inventory as of this Action Requested Previously Approved
07/31/1983 07/31/1983 07/31/1983
21,250 0 21,250
1,771 0 177
0 0 0

THIS FORM IS USED WHEN PAYMENT OF VA BENEFITS IS TO BE MADE TO A FIDUCIARY ON BEHALF OF A BENEFICIARY WHO IS INCOMPETENT, A MINOR, OR UNDER SOME OTHER LEGAL DISABILITY. IT IS AN AGREEMENT TO THE USE OF VA DERIVED FUNDS, AND WHEN COMPLETED BY THE VA AND SIGNED BY THE FIDICIARY IT CONSTITUTES A LEGAL BINDING CONTRACT (38 USC 3202).

None
None


No

1
IC Title Form No. Form Name
FIDUCIARY AGREEMENT 27-4703

  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 21,250 21,250 0 0 0 0
Annual Time Burden (Hours) 1,771 177 0 0 1,594 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/08/1982


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