APPROVED WITH
THE UNDERSTANDING THAT SSA WILL USE A COPY OF THE FIRST PAGE OF VA
FORM 21-534 (OMB 2900-0004) FOR INITIATING DETERMINATIONS OF
SURVIVORS ELIGIBILITY FOR SSA BENEFITS AS SOON AS THE REVISED VA
FORM INCORPORATING THE SSA-24 IS PLACED IN USE. SSA WILL SUBMIT A
CHANGE REQUEST TO ADJUST THE BURDEN HOURS TO REFLECT JOINT SSA AND
VA USE OF PART OF THE VA APPLICATION.
Inventory as of this Action
Requested
Previously Approved
12/31/1986
12/31/1986
12/31/1983
160,000
0
160,000
40,000
0
40,000
0
0
0
THIS FORM IS NEEDED TO SATISFY THE
"JOINTLY PRESCRIBED APPLICATION" PROVISION STATING THAT SURVIVORS
OF VETERANS WHO FILE WITH EITHER THE VA OR SSA SHALL ALSO BE DEEMED
TO HAVE FILED WITH BOTH AGENCIES AND TH EACH AGENCY'S FORMS MUST
REQUEST SUFFICIENT INFORMATION TO TO CONSITUTE AN APPLICATION FOR,
AND MUST BE FORWARDED TO, THE OTHER AGENCY.
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.