Request for Contact Information

ICR 200503-2900-016

OMB: 2900-0660

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
28938 Migrated
ICR Details
2900-0660 200503-2900-016
Historical Active
VA
Request for Contact Information
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/03/2005
Retrieve Notice of Action (NOA) 03/23/2005
  Inventory as of this Action Requested Previously Approved
06/30/2008 06/30/2008
5,000 0 0
1,250 0 0
0 0 0

VA Form Letter 21-30 is used to locate individuals when a field examination is necessary to maintain program integrity. The form is used when contact information cannot be obtained by other means and travel funds may be significantly impacted. Without this information, VA could not effectively administer its benefit programs, and misuse of funds and fraud could continue.

None
None


No

1
IC Title Form No. Form Name
Request for Contact Information 21-30

  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 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 1,250 0 0 1,250 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.
03/23/2005


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