DISABILITY BENEFITS QUESTIONNAIRE

ICR 198608-2900-047

OMB: 2900-0153

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
174384 Migrated
ICR Details
2900-0153 198608-2900-047
Historical Active 198404-2900-003
VA
DISABILITY BENEFITS QUESTIONNAIRE
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/08/1986
Approved with change 08/08/1986
Retrieve Notice of Action (NOA) 08/08/1986
  Inventory as of this Action Requested Previously Approved
05/31/1987 05/31/1987 05/31/1987
92,000 0 102,000
23,000 0 25,500
0 0 0

THIS FORM IS USED TO REQUEST INDUSTRIAL AND MEDICAL DATA IN CONJUNCTIO WITH A CONTINUING AWARD OF DISABILITY INSURANCE BENEFITS. THE CODE OF FEDERAL REGULATIONS REQUIRE THAT PROOF OF CONTINUING TOTAL DISABILITY FURNISHED TO THE VA TO PROVIDE FOR CONTINUANCE OF WAIVER OF PREMIUMS O DISABILITY PAYMENTS.

None
None


No

1
IC Title Form No. Form Name
DISABILITY BENEFITS QUESTIONNAIRE 29-8313

  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 92,000 102,000 0 0 -10,000 0
Annual Time Burden (Hours) 23,000 25,500 0 0 -2,500 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.
08/08/1986


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