APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION BY A SURVIVING SPOUSE OR CHILD (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION, WHERE APPLICABLE)
ICR 198606-2900-008
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⚠️ Notice: This information collection may be outdated.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 A SURVIVING SPOUSE
OR CHILD (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION, WHERE
APPLICABLE)
THIS FORM IS
APPROVED SUBJECT TO THE FOLLOWING CONDITIONS: 1. THE NOTE PRIOR TO
PART IV WILL BE CHANGED TO STATE: "NOTE: IF YOU ARE ONLY APPLYING
FOR DEPENDENCY AND INDEMNITY COMPENSATION, DO NOT COMPLETE PARTS IV
AND V, OR VI. FOR EXAMPLE, IF THE VETERAN DIED WHILE IN ACTIVE DUTY
OR DIED DUE TO A SERVICE-CONNECTED CONDITION." 2. ITEM 23B WILL BE
ELIMINATED SINCE THAT INFORMATION IS UNNECESSARY FOR VA'S
EVALUATION OF THIS APPLICATION. VA SHOULD REVIEW THE BURDEN
REDUCTION IMPLICATIONS OF THESE CHANGES AND SUBMIT AN INVENTORY
CORRECTION WORKSHEET IF APPROPRIATE.
Inventory as of this Action
Requested
Previously Approved
06/30/1987
06/30/1987
06/30/1988
162,720
0
162,723
203,400
0
244,500
0
0
0
THE FORM IS REQUIRED TO OBTAIN
NECESSARY INFORMATION TO DETERMINE A SPOUSE'S AND/OR CHILD(REN)'S
ELIGIBILITY, DEPENDENCY, AND INCOME DATA, AS APPLICABLE, FOR THE
BENEFIT SOUGHT.
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.