Application for Accrued Amounts Due a Deceased Beneficiary
2900-0216
VA Form 21P-601
Justification
Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.
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 transferred from Compensation Service to Pension and Fiduciary Service, due a change in business lines.
Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.
VA Form 21P-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.
Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.
VA Form 21P-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.
Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.
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.
If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.
The collection of information does not involve small businesses or entities.
Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.
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.
Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.
There is no special circumstance requiring collection in a manner inconsistent with 5 CFR 1320.6 guidelines.
If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.
The Department notice was published in the Federal Register on August 15, 2014, Volume 79, No. 158, pages 48297 and 48298. VA received one public comment from Mr. Gabriel Blau on the behalf of Family Equality Council. Mr. Blau proposed we removed Father and Mother from the form. We responded to Mr. Blau thanking him for his recommendation on behalf of the Family Equality Council. VA Form 21P-601, Application for Accrued Amounts Due a Deceased Beneficiary, has been updated to replace the terms “mother” and “father” with “parent,” to better match the language in 38 U.S.C. § 103(c).
Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.
No payments or gifts to respondents have been made under this collection of information.
Describe any assurance of privacy, to the extent permitted by law, provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
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).
Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.
There are no questions of a sensitive nature.
Estimated of the hour burden of the collection of information:
Estimate of Information Collection Burden.
List as sub-items (a, b, c, d, e, etc.):
Number of Respondents: 4,600
Frequency of Response: One time
Annual Burden Hours: 2,300
Estimated Completion Time: 30 minutes
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).
Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).
This submission does not involve any recordkeeping costs.
Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.
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
Explain the reason for any burden hour changes since the last submission.
The changes are non-substantive changes to update language to be in compliance with the Defense of Marriage Act. The expiration date placeholder has been added to the form.
For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.
The information collection is not for publication or tabulation use.
If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
We are not seeking approval to omit the expiration date for OMB approval.
Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.
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.
| File Type | application/msword |
| File Title | SF 83 SS VAF 21-8926 |
| Author | Veterans Benefits Administrat |
| Last Modified By | Department of Veterans Affairs |
| File Modified | 2015-07-20 |
| File Created | 2015-07-20 |