Application for Accrued Amounts Due a Deceased Beneficiary (21-601)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 21-601 Application for Accrued Amounts Due a Deceased Beneficiary	Form	Modified	Available
supplementary Document 21-601 (6-19-14).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2014-06-19	Available
Supporting Statement for VAF 21-601 (6-19-14).doc	Supporting Statement A	Uploaded 2014-06-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28464	Application for Accrued Amounts Due a Deceased Beneficiary	Form	Modified

ICR Details

OMB Control No: 2900-0216	ICR Reference No: 201406-2900-038
Status: Historical Active	Previous ICR Reference No: 201305-2900-011
Agency/Subagency: VA	Agency Tracking No: 2900-0216 VBA-P&F-NK
Title: Application for Accrued Amounts Due a Deceased Beneficiary (21-601)
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:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	11/30/2016	11/30/2016
Responses	4,600	0	4,600
Time Burden (Hours)	2,300	0	2,300
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-601 is used to gather information that is necessary to determine entitlement to accrued benefits, amounts of VA benefits due and unpaid to a deceased beneficiary at the time of death. Benefits are paid to survivors based on the order of preference shown in 38 U.S.C. 5121; however, when there are no eligible survivors, benefits may be paid as reimbursement to the person or persons who bore the expenses of the beneficiary's last illness and burial. Without this information, VA would be unable to properly authorize benefits.

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Authorizing Statute(s): US Code: 38 USC 5121 Name of Law: Payment of certain accrued benefits upon death of a beneficiary
  

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:
	78 FR 109	06/06/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 183	09/20/2013
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Accrued Amounts Due a Deceased Beneficiary	VA Form 21-601	Application for Accrued Amounts Due a Deceased Beneficiary

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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	4,600	4,600	0	0	0	0
Annual Time Burden (Hours)	2,300	2,300	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: $174,000

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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