STATEMENT IN SUPPORT OF CLAIM

ICR 199307-2900-006

OMB: 2900-0075

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
146898 Migrated
ICR Details
2900-0075 199307-2900-006
Historical Active 199009-2900-005
VA
STATEMENT IN SUPPORT OF CLAIM
Extension without change of a currently approved collection   No
Regular
Approved without change 08/18/1993
Retrieve Notice of Action (NOA) 07/01/1993
  Inventory as of this Action Requested Previously Approved
08/31/1996 08/31/1996 09/30/1993
752,000 0 752,000
188,000 0 188,000
0 0 0

VA FORM 21-4138 IS USED BY CLAIMANTS TO PROVIDE SELF-CERTIFIED STATEMENTS IN SUPPORT OF VARIOUS TYPES OF CLAIMS PROCESSED BY THE AGENCY.

None
None


No

1
IC Title Form No. Form Name
STATEMENT IN SUPPORT OF CLAIM 21-4138

  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 752,000 752,000 0 0 0 0
Annual Time Burden (Hours) 188,000 188,000 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.
07/01/1993


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