APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION WHERE APPLICABLE) FROM THE VETERANS ADMIN.

ICR 198904-2900-017

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 198904-2900-017
Historical Active 198804-2900-005
VA
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION OR DEATH PENSION (INCLUDING ACCRUED BENEFITS AND DEATH COMPENSATION WHERE APPLICABLE) FROM THE VETERANS ADMIN.
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/03/1989
Approved with change 04/03/1989
Retrieve Notice of Action (NOA) 04/03/1989
  Inventory as of this Action Requested Previously Approved
04/30/1991 04/30/1991 04/30/1991
28,200 0 28,200
4,700 0 4,700
0 0 0

DISABILITY COMPENSATION, VETERANS' PENSION BENEFITS' 38 USC 3005 REQUIRES THAT A JOINT FORM BE USED BY SURVIVORS OF VETERAN OR SERVICE PERSONNEL FOR BENEFITS FOR SOCIAL SECURITY AND VETERANS ADMINISTRATION BENEFITS. THIS FORM ACCOMPLISHES THE REQUIREMENT.

None
None


No

  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.
04/03/1989


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