Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans (VA Form 21-0304)

Forms and Documents

Document Name	Status
Form 21-0304 Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans Form	Modified
SuppStmt, VAF 21-0304, 7-29-14.docx Supporting Statement A	2014-07-29

IC Document Collections

IC ID	Document Title	Status
28777	Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans Form	Modified

ICR Details

OMB Control No: 2900-0572	ICR Reference No: 201407-2900-016
Status: Historical Inactive	Previous ICR Reference No: 201209-2900-014
Agency/Subagency: VA	Agency Tracking No: 2900-0572
Title: Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans (VA Form 21-0304)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/26/2014
	Date Received in OIRA: 07/30/2014
Terms of Clearance: VA has requested to withdraw this information collection request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved	06/30/2016
Responses	430	0	430
Time Burden (Hours)	72	0	72
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-0304 is used to gather information necessary to determine eligibility for a monetary allowance for a child born with spina bifida or certain birth defects who is a natural child of a Vietnam veteran.

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Authorizing Statute(s): US Code: 38 USC Section 1805 Name of Law: Monetary allowance
   US Code: 38 USC Section 1815 Name of Law: Monetary allowance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO81	Proposed rulemaking	78 FR 211	10/31/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans	21-0304	Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veteran

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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: $4,434

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: 07/30/2014

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