REQUEST FOR DETAILS OF EXPENSES

ICR 197808-2900-009

OMB: 2900-0138

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
174350 Migrated
ICR Details
2900-0138 197808-2900-009
Historical Active 197609-2900-003
VA
REQUEST FOR DETAILS OF EXPENSES
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/04/1978
Approved with change 08/04/1978
Retrieve Notice of Action (NOA) 08/04/1978
  Inventory as of this Action Requested Previously Approved
08/31/1981 08/31/1981 08/31/1981
24,000 0 24,000
6,000 0 8,000
0 0 0

THIS FORM IS USED TO REPORT EXPENSES FOR DEPENDENTS, MEDICAL AND EDUCATIONAL EXPENSES, EXPENSES OF LAST ILLNESS AND BURIAL AND RECEIPT OF LIFE INSURANCE PAYMENTS. THIS INFORMATION GENERALLY IS USED UNDER VARIOUS TYPES OF BENEFIT CLAIMS TO DETERMINE ANY ADJUSTMENTS WHICH WILL AFFECT THE CLAIMANTS MONTHLY AWARD. AUTHORITY IS 38 U.S.C. 522 AND 543.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR DETAILS OF EXPENSES 21-8049

  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 24,000 24,000 0 0 0 0
Annual Time Burden (Hours) 6,000 8,000 0 0 -2,000 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.
08/04/1978


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