2900-0004SuppStmt(7.30.14)

Supporting Statement for VA Forms 21P-534, 21P-534a (2900-0004) and

21P-534EZ (formerly 2900-0747)

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; Application for DIC, Death Pension, and or, Accrued Benefits

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 these forms under the authority of 38 U.S.C. 1310 through 1314 and 1532 through 1543. These forms are being transferred from Compensation Service (21) to Pension and Fiduciary Service (21P) due to a change in business line responsibilities, therefore the form prefix has been changed to 21P.

The Final Rule RIN 2900-AO81, Standard Claims and Appeals Forms, which requires all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is codifying its regulations to standardize the use of all VA forms, to include VA Forms 21P-534, 21P-534a and 21P-534EZ.

2. VA Form 21P-534 is used to gather the necessary information to determine the eligibility of surviving spouses and children for dependency and indemnity compensation (DIC), death pension, accrued benefits, and death compensation. VA Form 21P-534a is an abbreviated application for DIC that is used only by surviving spouses and children of veterans who died while on active duty service. The VA Form 21P-534EZ is used for the Fully Developed Claims (FDC) program for pension claims.

3. VA Forms 21P-534, 21P-534a and 21P-534EZ are available on the One-VA Website in a fillable electronic format. VBA is currently hosting these forms 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 proof of age and/or relationship for payment of benefits and additional benefits for dependents. Income information is also necessary to determine entitlement to death pension. 38 U.S.C. 5101 states that when a claimant files a claim for death benefits VA must consider entitlement to all death benefits. Therefore, VA Form 21P-534 requests all the information needed to determine eligibility for DIC, death pension, accrued benefits, and death compensation. Very few applicants are entitled to death compensation. If entitlement to both DIC and death pension is established, VA pays the greater benefit.

VA Form 21P-534a requests only the information that is needed from the claimant in order to process a claim based on in-service death. When a service member dies in service, the surviving spouse and/or children are entitled to DIC. Accrued benefits and death compensation are not payable in these cases, and DIC is always a greater benefit than death pension. Additionally, service and death information are provided to VA by the Department of Defense, so VA Form 21P-534a also does not request this information from the claimant.

The VA Form 21P-534EZ is used in the fully developed claims (FDC) program.

Without this collection of information, entitlement to benefits could not be determined.

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 proposed rule, RIN 2900-AO81, Standard Claims and Appeals Forms, in the Federal Register on October 31, 2013, pages 65490-65509. No comments were received.

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.

1. Number of Respondents: 145,520:

   • 32,438 for VA Form 21P-534

   • 1,426 for VA Form 21P-534a

   • 111,656 for VA Form 21P-534EZ

2. Frequency of Response: one time.

2. Annual Burden Hours: 87,428:

• 46,523 for VA Form 21P-534EZ

• 40,905 for VA Forms 21P-534 and 21P534a

2. Estimated Completion Time:

• 75 minutes for VA Form 21P-534

• 15 minutes for VA Form 21P-534a

• 25 minutes for VA Form 21P-534EZ

2. 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 $2,098,272 (87,428 burden hours x $24 per hour).

13. This submission does not involve any recordkeeping costs.

14. Estimated Costs to the Federal Government:

1. Processing/Analyzing costs $6,996,358

VA Form 21P-534

(GS-11/5 @ $33.92 x 32,438 x 75/60 minutes = $1,375,371)

(GS-10/5 @ $30.88 x 32,438 x 75/60 minutes = $1,252,106)

(GS-3/5 @ $14.73 x 32,438 x 75/60 minutes = $ 597,264)

VA Form 21P-534a

(GS-11/5 @ $33.92 x 1,426 x 15/60 minutes = $12,092)

(GS-10/5 @ $30.88 x 1,426 x 15/60 minutes = $11,008)

(GS- 3/5 @ $14.73 x 1,426 x 15/60 minutes = $5,251)

VA Form 21-534EZ

(GS-11/5@ $33.92 x 111,656 x 25/60 minutes = $1,578,071)

(GS-9/5 @ $28.04 x 111,656 x 25/60 minutes = $1,304,514)

(GS-5/5 @ $18.50 x 111,656 x 25/60 minutes = $ 860,681)

2. Forms are available on the VA inter/intranet forms websites.

3. Printing and production cost ($90/thousand) $77,737

4. Total cost to government $7,074,095

15. The increase in the number of respondents is due to the addition of VA Form 21P-534EZ to this information collection.

The increase in burden is due to the Final Rule RIN 2900-AO81, Standard Claims and Appeals Forms which requires all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is codifying its regulations to standardize the use of all VA forms, to include VA Forms 21P-534, 21P-534a, and 21P-534EZ. Currently, other than for the initial original claim, VA does not require that claimants submit any subsequent claim on a prescribed VA form. Although there is no substantive change in these forms, VA expects a change in the number of respondents submitting VA Forms 21P-534, 21P-534a, and 21P-534EZ. The total estimated costs to respondents and the federal government have changed as shown in paragraphs 12 and 14 of this statement. The expiration date placeholder has been added to the forms.

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.