Certificate as to Assets

ICR 200510-2900-004

OMB: 2900-0107

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
28292 Migrated
ICR Details
2900-0107 200510-2900-004
Historical Active 200210-2900-007
VA
Certificate as to Assets
Extension without change of a currently approved collection   No
Regular
Approved with change 12/22/2005
Retrieve Notice of Action (NOA) 10/31/2005
Approved consistent with the following terms of clearance: in the next submission of this collection of information to OMB VA shall report on the feasibility of accepting electronic signatures and providing respondents with a fully automated version of associated forms.
  Inventory as of this Action Requested Previously Approved
12/31/2008 12/31/2008 12/31/2005
4,316 0 4,316
863 0 863
0 0 0

VA Form 21-4709 is used by fiduciaries of VA beneficiaries to report investments in savings, bonds, and other securities that are part of beneficiaries' estates. The information is used by VA to audit accountings of fiduciaries. Without this information, beneficiaries' funds would be more vulnerable to waste, fraud, and abuse by fiduciaries.

None
None


No

1
IC Title Form No. Form Name
Certificate as to Assets 21-4709

  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 4,316 4,316 0 0 0 0
Annual Time Burden (Hours) 863 863 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.
10/31/2005


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