STATEMENT IN SUPPORT OF CLAIM

ICR 197709-2900-005

OMB: 2900-0075

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
174195 Migrated
ICR Details
2900-0075 197709-2900-005
Historical Active 197707-2900-008
VA
STATEMENT IN SUPPORT OF CLAIM
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/16/1977
Approved with change 09/16/1977
Retrieve Notice of Action (NOA) 09/16/1977
  Inventory as of this Action Requested Previously Approved
07/31/1982 07/31/1982 03/31/1978
800,000 0 800,000
200,000 0 200,000
0 0 0

THIS FORM IS USED AS A GENERAL PURPOSE FORM TO PRESENT A STATEMENT IN SUPPORT OF A CLAIM FOR VA BENEFITS. AUTHORITY IS 38 U.S.C. 210.

None
None


No

1
IC Title Form No. Form Name
STATEMENT IN SUPPORT OF CLAIM 21-4138

  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 800,000 800,000 0 0 0 0
Annual Time Burden (Hours) 200,000 200,000 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.
09/16/1977


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