FIDUCIARY AGREEMENT

ICR 198601-2900-010

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
174650 Migrated
ICR Details
2900-0319 198601-2900-010
Historical Active 198511-2900-002
VA
FIDUCIARY AGREEMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/08/1986
Approved with change 01/08/1986
Retrieve Notice of Action (NOA) 01/08/1986
  Inventory as of this Action Requested Previously Approved
10/31/1988 10/31/1988 10/31/1988
23,500 0 23,500
1,958 0 1,958
0 0 0

THIS FORM IS USED WHEN PAYMENT OF VA BENEFITS IS MADE TO A FIDUCIARY ON BEHALF OF A BENEFICIARY WHO IS INCOMPETENT, A MINOR, OR UNDER LEGAL DISABILITY. WHEN COMPLETED BY THE VA AND SIGNED BY THE FIDUCIARY, IT CONSTITUTES A LEGALLY BINDING CONTRACT AS TO THE USE OF VA FUNDS.

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 23,500 23,500 0 0 0 0
Annual Time Burden (Hours) 1,958 1,958 0 0 0 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.
01/08/1986


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