2900-0734SupportingState(9-8-15)

Supporting Statement for

VA Form 27-0820, Report of General Information

VA Form 27-0820a, Report of Death of Veteran/Beneficiary

VA Form 27-0820b, Report of Nursing Home Information

VA Form 27-0820c, Report of Defense Finance and Accounting Service (DFAS)

VA Form 27-0820d, Report of Lost Check

VA Form 27-0820e, Report of Incarceration

VA Form 27-0820f, Report of Contact - Month of Death Check

2900-0734

A. Justification

1. 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. 38 Code of Federal

Regulations 3.217 provides that action affecting entitlement to benefits may be taken based on

oral information or statements provided to VA by a beneficiary or his or her fiduciary.

2. 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 Forms 27-0820, 27-0820a, 27-0820b, 27-0820c, 27-0820d, 27-0820e and 27-0820f will be

used by VA Regional Office and Pension Maintenance Center employees to meet VA’s

requirement to document verbal evidence obtained telephonically from VA beneficiary or

claimant that will be used as part of the evidence for a claim for benefits. Without this

information action cannot be taken on any information received orally.

3. 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 currently does not use information technology to collect this information, since open-ended questioning may be needed to obtain complete information from the claimant or beneficiary.

4. 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.

5. 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.

6. 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.

Failure to collect this information would have a detrimental impact on the claimant or beneficiary since VA needs the information collected to determine entitlement to benefits.

7. 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.

8. 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 January 29, 2015, Vol. 80, No. 19, pages 4963-4964. There were no comments received in response to this notice.

9. 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.

10. 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 58VA21/22, "Compensation, Pension, Education and Rehabilitation Records - VA" as set forth in Privacy Act Issuances, 1993 compilation found in 42 Fed. Reg. 49726 (9/27//1977).

11. 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.

12. Estimate of the hour burden of the collection of information:

Estimate of Information Collection Burden.

a. Number of Respondents is estimated at 2,550,000 per year.

VA Form 27-0820, Report of General Information – 2,360,000.

VA Form 27-0820a, Report of Death of Veteran/Beneficiary – 80,000.

VA Form 27-0820b, Report of Nursing Home Information – 30,000.

VA Form 27-0820c, Report of Defense Finance and Accounting Service (DFAS) – 30,000

VA Form 27-0820d, Report of Lost Check – 30,000.

VA Form 27-0820e, Report of Incarceration – 10,000.

VA Form 27-0820f, Report of Contact - Month of Death Check – 10,000.

b. Frequency of Response is one time.

c. Annual Burden Hours is 212,500 hours.

VA Form 27-0820, Report of General Information – 19,668.

VA Form 27-0820a, Report of Death of Veteran/Beneficiary – 6,667.

VA Form 27-0820b, Report of Nursing Home Information – 2,500.

VA Form 27-0820c, Report of Defense Finance and Accounting Service (DFAS) – 2,500.

VA Form 27-0820d, Report of Lost Check – 2,500.

VA Form 27-0820e, Report of Incarceration – 833.

VA Form 27-0820f, Report of Contact - Month of Death Check – 833.

d. The estimated completion time is 5 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 $852,024 (35,501 hours x $24 per hour).

13. 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.

14. 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 $62,916,875

(GS-9/5 @ $27.37x 2,550,000 x 5 minutes = $58,161,125)

(GS-7/5 @ $22.38 x 2,550,000 x 5 minutes = $4,755,750)

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

c. Printing and production cost – N/A

d. Total cost to government $62,916,875

15. Explain the reason for any burden hour changes since the last submission

There is no change in the burden hours.

15. 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.

15. 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.

15. Explain each exception to the certification statement identified in Item 19,

“Certification for Paperwork Reduction Act Submissions,” of OMB 83-1.

This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

This data collection does not employ statistical methods.