Supporting Statement for Certificate of Fully Developed Claim
VA Form 21-0844
2900-XXXX
A. Justification
1. The Department of Veterans Affairs (VA), through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services established by law for veterans, service personnel, and their dependents and/or beneficiaries. Information is requested by this form under the authority of Public Law 110-389, § 221(a).
2. The Certification of Fully Developed Claim is currently in use by veterans or their representatives to file claims under the Fully Develoed Claim (FDC) pilot program established by Public Law 110-389, § 221(a). We plan to extend the pilot beyond the December 2009 expiration date.
3. The Certification of Fully Developed Claim is available on VA’s Internet site on the Compensation and Pension page under “What’s New.” VBA is currently hosting this form on a secure server and does not have the technology in place to allow for the complete submission of the form. Validation edits are performed to assure data integrity. The Department will not add the Certification fo Fully Devleoped Claim to Veterans Online Applications (VONAPP), due to the brief time one year time period.
4. Program reviews were conducted to identify potential areas of duplication; however, none were found to exist. There is no known Department or Agency which maintains the necessary information, nor is it available from other sources within our department.
5. The collection of information does not involve small businesses or entities.
6. The VA compensation and pension programs require that statements submitted by or on behalf of a claimant contain certification by the respondent that the information provided is true and correct. This form is designed to facilitate claims processing by providing a uniform format for the certification statement.
7. There is no special circumstance requiring collection in a manner inconsistent with 5 CFR 1320.6 guidelines.
8. The Department notice was published in the Federal Register on November 17. 2009, page 59349. No comments were received.
9. No payments or gifts to respondents have been made under this collection of information.
10. The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 (June 19, 2009).
11. There are no questions of a sensitive nature.
12. Estimate of Information Collection Burden.
a. Number of Respondents is estimated at 1,584 per year
b. Frequency of Response is on occasion for most beneficiaries.
c. Annual burden is 132 hours.
d. The estimated completion time of 5 minutes is based on review by staff.
e. The total estimated cost to respondents is $1,980 (132 hours x $15 per hour).
13. This submission does not involve any recordkeeping costs.
14. Estimated Costs to the Federal Government:
a. Processing/Analyzing costs $738
(GS-12/5 @ $39.70 x 132 x 5/60 minutes = $ 437)
(GS-9/5 @ $27.37 x 132 x 5/60 minutes = $301)
b. Printing and production cost $284
c. Total cost to government $1,022
This is a new collection of information.
16. The information collection is not for publication or tabulation use.
17. The collection instrument, Certification of Fully Developed Claim, may be reproduced and/or stocked by the respondents and veterans service organizations. This VA form does display an expiration date. .
This submission does not contain any exceptions to the certification statement.
B. Collection of Information Employing Statistical Methods
The data collection does not employ statistical methods.
| File Type | application/msword |
| File Title | SF 83 SS VAF 21-8926 |
| Author | Veterans Benefits Administrat |
| File Modified | 2010-02-05 |
| File Created | 2010-02-05 |