Information Collection

Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a....

IC 28073 under ICR 201504-2900-005 · OMB 2900-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0004 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 21P-534 Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a....	Form
VA Form 21P-534 Application for Dependency and Indemnity Compensation, D 21P-534(7-30-14).pdf www.va.gov/vaforms	Form
VA Form 21P-534a Application for Dependency and Indemnity Compensation by 21P-534a(7-30-14).pdf www.va.gov/vaforms	Form
VA Form 21P- 534EZ Application for DIC, Death Pension, and/or Accrued Benef 21P-534EZ(7-30-14).pdf www.va.gov/vaforms	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Application for Dependency and Indemnity Compensation (DIC), Death Pension and Accrued Benefits by a Surviving Spouse or Child (death Compensation...); Application for DIC by a....

Agency IC Tracking Number:

2900-0004

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21P-534	Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child	21P-534(7-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21P-534a	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only	21P-534a(7-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21P- 534EZ	Application for DIC, Death Pension, and/or Accrued Benefits	21P-534EZ(7-30-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 145,520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	145,520	145,520
Annual IC Time Burden (Hours)	87,428	87,428
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.