Statement of Disappearance

ICR 200411-2900-003

OMB: 2900-0036

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
28145 Migrated
ICR Details
2900-0036 200411-2900-003
Historical Active 200201-2900-005
VA
Statement of Disappearance
Extension without change of a currently approved collection   No
Regular
Approved without change 01/07/2005
Retrieve Notice of Action (NOA) 11/05/2004
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008 03/31/2005
10 0 10
28 0 28
0 0 0

Since no state law providing presumption of death is applicable to VA benefits, VA Form 21-1775 is needed to gather sufficient information from a claimant so a formal decision can be made regarding the unexplained absence of an individual for over 7 years.

None
None


No

1
IC Title Form No. Form Name
Statement of Disappearance 21-1775

  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 10 10 0 0 0 0
Annual Time Burden (Hours) 28 28 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.
11/05/2004


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