PARENT'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING PARENT'S DEPENDENCY QUESTIONNAIRE

ICR 198105-2900-004

OMB: 2900-0311

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
2900-0311 198105-2900-004
Historical Active
VA
PARENT'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING PARENT'S DEPENDENCY QUESTIONNAIRE
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/06/1981
Retrieve Notice of Action (NOA) 05/07/1981
THIS REQUEST IS APPROVED. BURDEN ESTIMATES WILL BE ADJUSTED 10/01/81.
  Inventory as of this Action Requested Previously Approved
07/31/1983 07/31/1983
61,000 0 0
20,333 0 0
0 0 0

THIS FORM IS USED TO OBTAIN DEPENDENCY EVIDENCE FOR CONTINUED ENTITLEMENT FROM DEPENDENT PARENTS OF DECEASED VETERANS WHO ARE IN RECEIPT OF DEATH COMPENSATION.

None
None


No

1
IC Title Form No. Form Name
PARENT'S DEPENDENCY QUESTIONNAIRE AND INSTRUCTIONS FOR COMPLETING PARENT'S DEPENDENCY QUESTIONNAIRE 21-4139 &, 21-4139A

  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 61,000 0 0 61,000 0 0
Annual Time Burden (Hours) 20,333 0 0 20,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/07/1981


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