Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a... (21-534,534a &534EZ)

Forms and Documents

Document Name	Status
Form VA Form 21-534 Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a.... Form	Modified
Supplemental Statement DOMA 21-534, a, & EZ.docx Justification for No Material/Nonsubstantive Change	2014-06-19
2900-0004 534.docx Supporting Statement A	2014-06-18

IC Document Collections

IC ID	Document Title	Status
28073	Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a.... Form	Modified

ICR Details

OMB Control No: 2900-0004	ICR Reference No: 201406-2900-036
Status: Historical Active	Previous ICR Reference No: 201107-2900-004
Agency/Subagency: VA	Agency Tracking No: 2900-0004 VBA-P&F-NK
Title: Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a... (21-534,534a &534EZ)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/19/2014
	Date Received in OIRA: 06/19/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	01/31/2015	01/31/2015
Responses	63,309	0	63,309
Time Burden (Hours)	76,736	0	76,736
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-534 requests the information necessary to determine entitlement to dependency and indemnity compensation (DIC), death pension, accrued benefits, and death compensation. VA Form 21-534a requests the information necessary to determine entitlement to DIC based on in-service death. Without this collection of information, VA would be unable to authorize and properly pay benefits. VA Form 21-534EZ is used for Fully developed claims.

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Authorizing Statute(s): US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1311 Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1312 Name of Law: Benefits in certain cases of in-service or service-connected deaths
   US Code: 38 USC 1313 Name of Law: Dependency and indemnity compensation to children
   US Code: 38 USC 1532 Name of Law: Surviving spouses of Civil War veterans
   US Code: 38 USC 1543 Name of Law: Net worth limitation
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1314 Name of Law: Supplemental dependency and indemnity compensation to children
   US Code: 38 USC 1533 Name of Law: Children of Civil War veterans
   US Code: 38 USC 1534 Name of Law: Surviving spouses of Indian War veterans
   US Code: 38 USC 1535 Name of Law: Children of Indian War veterans
   US Code: 38 USC 1536 Name of Law: Surviving spouses of Spanish-American War veterans
   US Code: 38 USC 1537 Name of Law: Children of Spanish-American War veterans
   US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 1542 Name of Law: Children of veterans of a period of war
   US Code: 38 USC 5101 Name of Law: Claims and forms
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 142	07/25/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 193	10/05/2011
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a....	VA Form 21-534, VA Form 21-534EZ, VA Form 21-534a	Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation If Applicable) ,   Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only ,   Application for DIC, Death Pension, and/or Accrued Benefits

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ICR Summary 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	63,309	63,309	0	0	0	0
Annual Time Burden (Hours)	76,736	76,736	0	0	0	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:

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Annual Cost to Federal Government: $5,517,096

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: 06/19/2014

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