Notice of Disagreement

Forms and Documents

Document Name	Status
Form 21-0958 Notice of Disagreement Form	Modified
2900-0791 Supporting Statement VAF 0958 9-12-13.doc Supporting Statement A	2013-09-12

IC Document Collections

IC ID	Document Title	Status
202598	Notice of Disagreement Form	Modified

ICR Details

OMB Control No: 2900-0791	ICR Reference No: 201309-2900-014
Status: Historical Inactive	Previous ICR Reference No: 201206-2900-001
Agency/Subagency: VA	Agency Tracking No: 2900-0791 VBA-COMP-NK
Title: Notice of Disagreement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 11/21/2013
	Date Received in OIRA: 09/19/2013
Terms of Clearance: The Department should resubmit this information collection once the final rule has been developed. VA is reminded to display the OMB Control Number and the expiration date on the online/electronic versions of the form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	03/31/2016
Responses	144,000	0	144,000
Time Burden (Hours)	72,000	0	72,000
Cost Burden (Dollars)	0	0	0

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Abstract: This is a new VA Form which will be used by the Veteran to indicate disagreement with a decision issued by a Regional Office (RO).

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Authorizing Statute(s): US Code: 38 USC 1114 Name of Law: Rates of wartime disability compensation
   US Code: 38 USC 1151(1)(E) Name of Law: Benefits for persons disabled by treatment or vocational rehabilitation
   US Code: 38 USC 1521(d) and (e) Name of Law: Veterans of a period of war
   US Code: 38 USC 1311(d) Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1541(d) and (e) Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 7105(a) Name of Law: Filing notice of disagreement and appeal
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO81	Proposed rulemaking	78 FR 211	10/31/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Notice of Disagreement	21-0958	Notice of Disagreement

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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:

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Annual Cost to Federal Government: $7,229,520

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

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Common Form ICR:  No

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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: 09/19/2013

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