APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY CHILD

ICR 198407-2900-012

OMB: 2900-0103

Federal Form Document

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ICR Details
2900-0103 198407-2900-012
Historical Active 198107-2900-048
VA
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY CHILD
Revision of a currently approved collection   No
Regular
Approved without change 09/25/1984
Retrieve Notice of Action (NOA) 07/30/1984
  Inventory as of this Action Requested Previously Approved
07/31/1987 07/31/1987 07/31/1984
7,900 0 8,500
1,975 0 2,125
0 0 0

VA FORM 21-4183 IS USED TO CLAIM DEPENDENCY AND INDEMNITY COMPENSATION BY A CHILD UNDER AGE 18 WHERE THE SURVIVING SPOUSE WAS NOT ENTITLED OR IS NO LONGER ENTITLED OR BY A CHILD AGE 18 OR OVER REGARDLESS OF THE SURVIVING SPOUSE'S ENTITLEMENT.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY CHILD 21-4183

  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 7,900 8,500 0 -600 0 0
Annual Time Burden (Hours) 1,975 2,125 0 -150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
07/30/1984


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