Application for Amounts on Deposit for Deceased Veteran

ICR 200107-2900-006

OMB: 2900-0133

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
28357 Migrated
ICR Details
2900-0133 200107-2900-006
Historical Active 200003-2900-005
VA
Application for Amounts on Deposit for Deceased Veteran
Extension without change of a currently approved collection   No
Regular
Approved without change 09/13/2001
Retrieve Notice of Action (NOA) 07/13/2001
  Inventory as of this Action Requested Previously Approved
09/30/2004 09/30/2004 10/31/2001
700 0 700
175 0 175
0 0 0

This form is used to collect information to process claims for payment of accrued amounts on deposit in the personal funds of patients account for deceased veterans.

None
None


No

1
IC Title Form No. Form Name
Application for Amounts on Deposit for Deceased Veteran VA-21-6998

  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 700 700 0 0 0 0
Annual Time Burden (Hours) 175 175 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.
07/13/2001


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