Income-Net Worth and Employment Statement

ICR 201203-2900-006

OMB: 2900-0002

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2012-12-07
IC Document Collections
IC ID
Document
Title
Status
28067 Modified
ICR Details
2900-0002 201203-2900-006
Historical Active 201006-2900-005
VA 2900-0002
Income-Net Worth and Employment Statement
Extension without change of a currently approved collection   No
Regular
Approved without change 12/21/2012
Retrieve Notice of Action (NOA) 07/26/2012
  Inventory as of this Action Requested Previously Approved
12/31/2015 36 Months From Approved 12/31/2013
104,440 0 104,440
104,440 0 104,440
0 0 0

VA Form 21-527 is necessary to obtain current employment, dependency, and family income and net worth information so VA can determine entitlement to disability pension. VA disability pension benefits are not payable without this information.

US Code: 38 USC 1503 Name of Law: Disability Pension Program
   US Code: 38 USC 1502 Name of Law: Disability Pension Program
  
None

Not associated with rulemaking

  77 FR 67 04/06/2012
77 FR 127 07/02/2012
No

1
IC Title Form No. Form Name
Income-Net Worth and Employment Statement VA Form 21-527 Income-Net Worth and Income Statement

  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 104,440 104,440 0 0 0 0
Annual Time Burden (Hours) 104,440 104,440 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$5,446,284
No
No
No
No
No
Uncollected
Denise McLamb 202-565-8374 [email protected]

  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.
07/26/2012


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