Fully Developed Claims- Applications for Compensation and Pension

Forms and Documents

Document Name	Status
Form VA Form 21-526EZ Fully Developed Claims- Applications for Compensation and Pension Form	Modified
Suppl Stmt - DOMA, 21-527EZ (non-sub).docx Justification for No Material/Nonsubstantive Change	2014-06-19
SuppStmt, 526EZ-527EZ (6-19-14).docx Supporting Statement A	2014-06-19

IC Document Collections

IC ID	Document Title	Status
191044	Fully Developed Claims- Applications for Compensation and Pension Form	Modified

ICR Details

OMB Control No: 2900-0747	ICR Reference No: 201406-2900-043
Status: Historical Active	Previous ICR Reference No: 201209-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0747
Title: Fully Developed Claims- Applications for Compensation and Pension
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	04/30/2016	04/30/2016	04/30/2016
Responses	69,626	0	104,440
Time Burden (Hours)	29,011	0	43,517
Cost Burden (Dollars)	0	0	0

---

Abstract: Public Law 110-389, Section 221(a)directs the Department of Veterans Affairs (VA) to expeditiously process fully developed compensation and pension claims within 90 days after receipt of the claim. The law requires the claimant and the representative submit a certification in writing that is signed and dated by the claimant stating that, as of such date, no additional information or evidence is available or needs to be submitted in order for the claim to be adjudicated.

---

Authorizing Statute(s): PL: Pub.L. 110 - 389 221 Name of Law: Veterans’ Benefits Improvement Act of 2008
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 203	10/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 19	01/29/2013
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Fully Developed Claims- Applications for Compensation and Pension	VA Form 21-527EZ, VA Form 21-526EZ	Application for Disability Compensation and Related Compensation Benefits ,   Application for Pension

---

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	69,626	104,440	0	-34,814	0	0
Annual Time Burden (Hours)	29,011	43,517	0	-14,506	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: VA is removing VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits, information collection (IC) from control number 2900-0747 and have it assigned to OMB control number 2900-0004, since it has been transferred to Pension & Fiduciary Service (21P). VA will retain all other ICs under OMB control number 2900-0747 until pending substantive revisions are complete. At which time, VA will request separate OMB control numbers for each IC. This change is necessary to provide VA with the flexibility to modify each form on an individual basis instead of limiting the changes to the original control number. VA needs the maximum flexibility because the content of the form is influenced by a multitude of unpredictable forces outside its control. As such, VA needs to maximize its ability to modify the forms consistent with the form contents' dynamic environment.

---

Annual Cost to Federal Government: $3,506,210

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

---

Common Form ICR:  No

---

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

---