2900-0005 Supporting Statement VAF 535 9-12-13

Supporting Statement for VA Form 21-535

Application for Dependency and Indemnity Compensation by Parent(s)

(Including Accrued Benefits and Death Compensation, When Applicable)

(2900-0005)

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. 38 U.S.C. 1121 and 1310 provide for payment of Dependency and Indemnity Compensation (DIC) or death compensation to parents of veterans whose deaths are service connected. Parents must also meet income limitations for DIC and death compensation. 38 U.S.C. 5121 provides for payment of accrued benefits. Information is requested by this form under the authority of 38 U.S.C. 501(a)(2).

2. VA Form 21-535 is used for the sole purpose of gathering the necessary information to determine a parent’s eligibility, dependency and income, as applicable, for the death benefit sought.

3. VA Form 21-535 is available as a fillable form on the VBA website for downloading by claimants. Claimants may print and submit applications non-electronically. VBA is currently hosting this form on a secure server and does not currently have the technology in place to allow for the complete submission of the form. Validation edits are performed to assure data integrity. Efforts within VA are underway to provide a mechanism to allow the information to be submitted electronically with a recognized signature technology. Veterans Online Applications (VONAPP) allows applicants to view, print, and submit applications electronically to VBA. VA Form 21-535 is not currently available in VONAPP; however, the form is scheduled to be added to VONAPP when the resources become available.

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 claimants to file an application for benefits subsequent to the death of the veteran to determine eligibility for the benefit. Without this information, entitlement to benefits could not be determined.

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 September 28, 2011, page 60132. There were no comments were received in response to this notice.

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 on June 19, 2009, and last amended at 77 FR 42593 (July 19, 2012).

11. There are no questions of a sensitive nature.

12. Estimate of Information Collection Burden.

a. Number of Respondents is estimated at 1,783 per year.

b. Frequency of Response is one time for most beneficiaries.

c. Annual burden is 2,140 hours.

d. The estimated completion time of 1 hour, 12 minutes is based on review by staff personnel and previous usage of this form.

e. The total estimated cost to respondents is $32,100 (2,140 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 $215,317

(GS-12/5 @ $40.66 x 2,140 x 72/60 minutes = $86,996)

(GS- 9/5 @ $28.04 x 2,140 x 154/60 minutes = $128,321)

b. Printing and production cost ($90 per thousand) $160

c. Total cost to government $215,478

15. There is a change in the annual expected number of respondents due to the Notice of Proposed Rulemaking (NPRM) RIN 2900-AO81, “Standard Claims and Appeals Forms” which proposes to require all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is proposing to codify its regulations to standardize the use of all VA forms, to include VA Form 21-535. Currently, other than for the initial original claim, VA does not require that claimants submit any subsequent claim on a prescribed VA form. Although there is no substantive change in this form, VA expects a change in the number of respondents submitting VA Form 21-535 on account of VA’s electronic claims processing system which will use another form, i.e., VA Form 21-534EZ, that contains the 38 U.S.C. 5103 notices to claimants. VA also expects that more respondents will be filing death benefit claims by parents in the fully developed claim program which requires the use of VA Form 21-534EZ. The total estimated costs to respondents and to the federal government have changed as shown in paragraphs 12 and 14 of this statement.

16. The information collection is not for publication or tabulation use.

17. The collection instrument, VA Form 21-535, may be reproduced and/or stocked by the respondents and veterans service organizations. This VA form does not display an expiration date, and if required to do so would result in unnecessary waste of existing stocks of this form. This form is submitted to OMB every 3 years. As such, this date requirement would also result in an unnecessary burden on the respondents and would delay Department action on the benefit being sought. VA also seeks to minimize its cost to itself of collecting, processing and using the information by not displaying the expiration date. For the reasons stated, VA continues to seek an exemption that waives the displaying of the expiration date on VA Form 21-535.

18. This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

The Veterans Benefits Administration does not collect information employing statistical methods.