APPLICATION FOR DIC OR DEATH PENSION (INCLUDING ACCRUED BENEFITS AND DEATH COMP. WHERE APPLICABLE) FROM THE VA

ICR 198503-2900-007

OMB: 2900-0255

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
2900-0255 198503-2900-007
Historical Active 198204-2900-006
VA
APPLICATION FOR DIC OR DEATH PENSION (INCLUDING ACCRUED BENEFITS AND DEATH COMP. WHERE APPLICABLE) FROM THE VA
Revision of a currently approved collection   No
Regular
Approved without change 04/29/1985
Retrieve Notice of Action (NOA) 03/20/1985
  Inventory as of this Action Requested Previously Approved
04/30/1988 04/30/1988 04/30/1985
28,200 0 28,200
4,700 0 4,700
0 0 0

VA FORM 21-4182 IS USED AS A SUPPLEMENT TO SOCIAL SECURITY APPLICATION IN THOSE CASES IN WHICH AN APPLICANT APPEARS TO BE ELIGIBLE FOR VA PENSION OR DEPENDENCY AND INDEMNITY COMPENSATION, THE SSA FORWARDS THE APPLICATION TO THE VA FOR PROCESSING.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR DIC OR DEATH PENSION (INCLUDING ACCRUED BENEFITS AND DEATH COMP. WHERE APPLICABLE) FROM THE VA VA-21-4182

  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 28,200 28,200 0 0 0 0
Annual Time Burden (Hours) 4,700 4,700 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
03/20/1985


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