APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION BY SURVIVING SPOUSE OR CHILD (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION, WHERE APPLICABLE)
ICR 198208-2900-005
OMB: 2900-0004
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0004 can be found here:
APPLICATION FOR DEPENDENCY
AND INDEMNITY COMPENSATION OR DEATH PENSION BY SURVIVING SPOUSE OR
CHILD (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION, WHERE
APPLICABLE)
This information
collection request is approved through 9/30/83 on the condition
that the following items related to the surviving spouse are
deleted: 18 - Date Remarried, 19 - Place Remarried (18 and 19 are
duplicative of 20), and 23 - Place of Birth (lack of practical
utility Any resubmission for extension should clearly justify the
need for items 7, 8, 9, and 10 and explain the practical utility of
11A.
Inventory as of this Action
Requested
Previously Approved
09/30/1983
09/30/1983
08/31/1983
164,500
0
164,500
342,708
0
287,875
0
0
0
VA FORM 21-534 IS AN INITIAL
APPLICATION REQUIRED TO FILE A CLAIM FOR DEPENDENCY AND INDEMNITY
COMPENSATION OR DEATH PENSION BENEFITS BY A SURVIVING SPOUSE AND/OR
CHILD/REN. THE INFORMATION REQUIRED IS USED T DETERMINE
ELIGIBILITY, DEPENDENCY, DISABILITY AND INCOME DATA, AS APPLICABLE.
AUTHORITY IS TITLE 38 U.S.C. CHAPTERS 13 AND 15.
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.