Court Appointed Fiduciary's Account, Federal Fiduciary's Account, Account Book, Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and Authorization to Disclose Financial Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 21-4706c Court Appointed Fiduciary's Account	Form	Modified	Available
Form VA Form 21-4706b Federal Fiduciary's Account	Form	Modified	Available
Form VA Form 21-4706 Annual-Final Report and Account	Form	Modified	Available
Form VA Form 21-4718a Certificate of Balance on Deposit and Authorization to Disclose Financial Records	Form	Modified	Available
Form VA Form 21-4718 Account Book	Form	Modified	Available
2900-0017 justification.docx	Supporting Statement A	Uploaded 2012-09-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28106	Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	Form	Modified	Court Appointed Fiduciary's Account
28106	Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	Form	Modified	Federal Fiduciary's Account
28106	Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	Form	Modified	Annual-Final Report and Account
28106	Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	Form	Modified	Certificate of Balance on Deposit and Authorization to Disclose Financial Records
28106	Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	Form	Modified	Account Book

ICR Details

OMB Control No: 2900-0017	ICR Reference No: 201205-2900-004
Status: Historical Active	Previous ICR Reference No: 200906-2900-009
Agency/Subagency: VA	Agency Tracking No: 2900-0017
Title: Court Appointed Fiduciary's Account, Federal Fiduciary's Account, Account Book, Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and Authorization to Disclose Financial Records
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/27/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved	12/31/2012
Responses	31,512	0	31,512
Time Burden (Hours)	29,566	0	29,569
Cost Burden (Dollars)	0	0	0

---

Abstract: VA Forms 21-4706, 21-4706b, 21-4706c, and 21-4718 are used to gather information necessary to determine the accounting of the veteran's compensation or pension funds spent and/or saved by his fiduciary appointment. VA Form 21-4718a is used to gather information from the veteran's financial institution records. Without this information, VA would be unable to determine if the veteran's fiduciary is properly using the funds for this benefit according to VA law.

---

Authorizing Statute(s): PL: Pub.L. 108 - 454 502-504 Name of Law: Veterans Benefits Improvement Act of 2004
   US Code: 38 USC 5502 Name of Law: Payments to and supervision of fiduciaries
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 127	07/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 178	09/13/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Court Appointed Fiduciary's Account (letter size), Federal Fiduciary's Account, Account Book, and Court Appointed Fiduciary's Account, Certificate of Balance on Deposit and....	VA Form 21-4706c, VA Form 21-4718, VA Form 21-4706, VA Form 21-4718a, VA Form 21-4706b	Account Book ,   Certificate of Balance on Deposit and Authorization to Disclose Financial Records ,   Annual-Final Report and Account ,   Federal Fiduciary's Account ,   Court Appointed Fiduciary's Account

---

ICR Summary of Burden

table that charts list of burden

	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	31,512	31,512	0	0	0	0
Annual Time Burden (Hours)	29,566	29,569	0	0	-3	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Adjustment is due to an error in the calculation.

---

Annual Cost to Federal Government: $908,121

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/27/2012

---