ANNUAL INCOME REPORTING (QUESTIONNAIRE)

ICR 198404-2900-001

OMB: 2900-0101

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
147047 Migrated
ICR Details
2900-0101 198404-2900-001
Historical Active 198308-2900-013
VA
ANNUAL INCOME REPORTING (QUESTIONNAIRE)
Revision of a currently approved collection   No
Regular
Approved without change 05/01/1984
Retrieve Notice of Action (NOA) 04/02/1984
APPROVED WITH CHANGES TO QUESTIONS ON MEDICAL EXPENDITURES AS AGREED TO BY VA.
  Inventory as of this Action Requested Previously Approved
02/28/1986 02/28/1986 04/30/1985
1,600,000 0 50,000
400,000 0 16,667
0 0 0

TO OBTAIN INCOME AND NET WORTH FOR CONTINUED ENTITLEMENT FROM VETERANS AND QUALIFYING SURVIVORS IN RECEIPT OF PENSION OR DEPENDENCY INDEMNITY COMPENSATION.

None
None


No

1
IC Title Form No. Form Name
ANNUAL INCOME REPORTING (QUESTIONNAIRE) VA 21-4179, 21-8913, THROUGH 8920

  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 1,600,000 50,000 0 1,550,000 0 0
Annual Time Burden (Hours) 400,000 16,667 0 383,333 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.
04/02/1984


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