Income-Net Worth and Employment Statement

ICR 200011-2900-006

OMB: 2900-0002

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
28064 Migrated
ICR Details
2900-0002 200011-2900-006
Historical Active 199703-2900-002
VA
Income-Net Worth and Employment Statement
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 05/10/2001
Retrieve Notice of Action (NOA) 11/30/2000
Approved consistent with clarifications in VA memos of 3-6-01 and 4-24-01. VA agrees to hold focus groups and/or conduct outreach to determine the feasibility and desirability of eliminating this form and having veterans applying for pensions use part D of VA form 21-526 (OMB #2900-0001). VA will report on the result of this effort in their next submission. This collection previously expired in June 2000. VA shall ensure that such future violations of the Paperwork Reduction Act do not occur.
  Inventory as of this Action Requested Previously Approved
05/31/2003 05/31/2003
104,440 0 0
104,440 0 0
0 0 0

Va Form 21-527 is used to solicit income, net worth, and employment information. This information is used to determine eligibility and benefit rates for veterans' disability pension and compensation based on individual unemployability..

None
None


No

1
IC Title Form No. Form Name
Income-Net Worth and Employment Statement 21-527

  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 104,440 0 0 104,440 0 0
Annual Time Burden (Hours) 104,440 0 0 104,440 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
11/30/2000


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