Supporting Statement for VAF 21-601 (6-19-14)

Supporting Statement for VA Form 21-601

Application for Accrued Amounts Due a Deceased Beneficiary

(2900-0216)

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. Information is requested by this form under the authority of 38 U.S.C. 5121 which provides the eligibility criteria for the payment of accrued benefits. Regulatory authority is found in 38 CFR 3.1000 and 38 CFR 3.1001. The form was transfer from Compensation Service to Pension and Fiduciary Service, due a change in business lines. Also additional information is necessary from the claimant in order to process the claim properly.

2. VA Form 21-601 is used to gather information that is necessary to determine entitlement to accrued benefits. Accrued benefits are 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 survivors who are entitled based on relationship, the person or persons who bore the expenses of the beneficiary’s last illness and burial may claim reimbursement for these expenses from accrued amounts.

3. VA Form 21-601 is available on the One-VA Website 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 may involve funeral businesses and other unpaid creditors. Specific instructions have been provided regarding the statements of account required to accompany the claim.

6. This form solicits information that is necessary to determine the proper payee for accrued benefits and the amount payable. Without the information provided on this form, it would not be possible to obtain the information needed to authorize benefits.

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 ( Insert Date ) (Volume___, No. ___) ( page/pages ) ( Insert Page Number(s) ). ( No or number ) 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.

List as sub-items (a, b, c, d, e, etc.):

a. Number of Respondents: 4,600

b. Frequency of Response: One time

c. Annual Burden Hours: 2,300

d. Estimated Completion Time: 30 minutes

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 $55,200. (2,300 burden 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 $173,580

(GS-12/5 @ $48.35 x 4,600 x 15/60 = $55,603)

(GS-9/5 @ $28.04 x 4,600 x 47/60 = $101,037)

(GS-3/5 @ $14.73 x 4,600 x 15/60 = $16,940)

b. Printing and production cost $0.00

c. Total cost to government $173,580

15. The changes are non-substantive changes to update language to be in compliance with the Defense of Marriage Act.

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

This collection of information does not employ statistical methods.