APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION FOR WIDOWER OR CHILD

ICR 197809-2900-006

OMB: 2900-0004

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2900-0004 197809-2900-006
Historical Active 197710-2900-008
VA
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION FOR WIDOWER OR CHILD
Revision of a currently approved collection   No
Regular
Approved without change 10/13/1978
Retrieve Notice of Action (NOA) 09/12/1978
  Inventory as of this Action Requested Previously Approved
08/31/1983 08/31/1983 10/31/1982
175,000 0 175,000
306,250 0 306,250
0 0 0

THIS APPLICATION FORM IS REQUIRED TO FILE A CLAIM FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH BENEFITS. THE INFORMATION REQUIRED IS USED TO DETERMINE ELIGIBILITY, DEPENDENCY, DISABILITY AND INCOME DATA, AS APPLICABLE. AUTHORITY IS 38 U.S.C. CHAPTER 13 AND 15, SUBCHAPTER.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION FOR WIDOWER OR CHILD 21-534

  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 175,000 175,000 0 0 0 0
Annual Time Burden (Hours) 306,250 306,250 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.
09/12/1978


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