Information Collection

Aplication for Survivors' and Dependents' Assistance (Under Provisions of Chapter 35, Title 38, U.S.C.), VA Form 22-5430

IC 28269 under ICR 200601-2900-009 · OMB 2900-0098.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0098 can be found here:

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Information Collection (IC) Details

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IC Title:	Aplication for Survivors' and Dependents' Assistance (Under Provisions of Chapter 35, Title 38, U.S.C.), VA Form 22-5430	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	22-5490				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40,000	1,935	13,065	25,000
Annual IC Time Burden (Hours)	28,000	2,000	13,500	12,500
Annual IC Cost Burden (Dollars)	0	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.