Supporting Statement for VA Form 21-4103
Information from Remarried Widow(er)
(2900-0038)
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 survivors. Death pension may be payable to eligible children of deceased veterans who served during a wartime period when there is not an eligible surviving spouse. Information is requested by this form under the authority of 38 U.S.C. 1503, (Determination with Respect to Annual Income), 1542 (Children of veterans of a period of war), and 1543 (Net worth limitation).
2. VA Form 21-4103 is used to gather information to determine if a child meets the requirements for death pension established under the law. The income and net worth of the child, remarried widow(er) and her/his spouse must be within the limits imposed by law.
3. VA Form 21-4103 is available on the One-VA web site in a fillable electronic format. 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. There currently is no utility process in place that will allow the data submitted on the form to be incorporated with an existing centralized legacy database.
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 current information to determine eligibility for benefits. When a surviving spouse receiving death pension remarries, her/his entitlement to death pension is permanently lost. However, the deceased veteran’s child or children may be eligible to death pension if the income and net worth of the child or children, remarried widow(er) and her/his spouse meet income and net worth limits. If the collection were not conducted, VA would be unable to determine a child's eligibility for death pension once a surviving spouse remarries.
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 December 17, 2013, Vol. 78, No. 242, page 76411. 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 58VA21/22/28,‘‘Compensation, Pension, Education, and Rehabilitation Records—VA ’’as set forth in Privacy Act Issuances, 1993 compilation found in 74 Fed. Reg. 117 (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 1,000 per year.
b. Frequency of Response is one time for most beneficiaries.
c. Annual burden is 334 hours.
d. The estimated completion time of 20 minutes is based on review by staff personnel and previous usage of this form.
e. According to the U.S. Bureau of Labor Statistics Average Hourly Earnings, the cost to the respondent is $24, making the total cost to the respondents an estimated $8,016 (334 hours x $24 per hour).
13. This submission does not involve any recordkeeping costs.
14. Estimated Costs to the Federal Government:
a. Processing/Analyzing costs $32,665
(GS-9/5 @ $28.04 x 1,000 x 60/60 minutes = $28,040)
(GS-5/5 @ $18.50 x 1,000 x 15/60 minutes = $ 4,625)
b. Printing and production cost $175
c. Total cost to government $32,840
15. There are no changes to the burden hours on this form. The form has been updated to include the expiration date placeholder.
16. The information collection is not for publication or tabulation use.
17. We are not seeking approval to omit the expiration date for OMB approval.
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.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Supporting Statement for VA Form 21-4103 |
| Author | VBA |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |