Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial and Accrued) (VA Form 21P-0970)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 21P-0970 Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial and Accrued	Form	New	Available
2900-NEW Supporting Statement VA Form 21P-0970_031417.docx	Supporting Statement A	Uploaded 2017-03-14	Available
21P-0970 VSO Comment Response.docx	Public Comments	Uploaded 2016-02-06	Repair queued
FW NOD Forms 21P-0970 comment .msg	Public Comments	Uploaded 2016-10-05	Repair queued
2900-NEW 21P-0970 NOVA Comment.pdf	Public Comments	Uploaded 2016-07-20	Repair queued
2900- NEW 21P-0970 60-Day FRN.pdf	Supplementary Document	Uploaded 2016-05-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221379	Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial, and Accrued), VA Form 21P-0970	Form	New	Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial and Accrued

ICR Details

OMB Control No: 2900-0854	ICR Reference No: 201605-2900-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial and Accrued) (VA Form 21P-0970)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/27/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/21/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved
Responses	12,000	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	121,350	0	0

---

Abstract: VA Form 21P-0970 will be used by the claimant to initiate an appeal by indicating disagreement with a decision issued by a VA Regional Office (RO) specifically related to a claim for VA pension benefits, dependency and indemnity compensation (DIC) benefits, burial benefits, and accrued benefits. VA Form 21P-0970 will be the claimant’s first step in the appeal process. The respondent may or may not continue with an appeal to the Board of Veterans Appeals (BVA). If the claimant opts to continue to BVA for an appeal, this form will be included in the claim folder as evidence. VA will provide VA Form 21P-0970 to the claimant with the notification letter of the decision in paper form or via hyperlink to VA’s website. The use of VA Form 21P-0970 will be mandatory when claimants initiate an appeal of a decision regarding pension, DIC, burial, or accrued claims for benefits. Currently, VBA does not have a mandatory form which would enable the claimant to initiate an appeal of a decision made regarding entitlement to pension, DIC, burial, or accrued benefits. As a result, claimants may provide their notice of disagreement in any format. The variety of submissions hampers efforts to identify, and process timely, the claimant’s appeal. With the implementation of this collection, the submissions will be standardized, increasing efficiency.

---

Authorizing Statute(s): US Code: 38 USC 7105 Name of Law: Filing of Notice of Disagreement and Appeal
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 12033	05/23/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 60414	09/01/2016
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial, and Accrued), VA Form 21P-0970	VA Form 21P-0970	Notice of Disagreement (NOD) (Pension, Dependency and Indemnity Compensation (DIC), Burial and Accrued

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,000	0	0	12,000	0	0
Annual Time Burden (Hours)	6,000	0	0	6,000	0	0
Annual Cost Burden (Dollars)	121,350	0	0	121,350	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a "New" Information Collection. The estimated number of annual responses and the annual time burden were obtained by an agency analysis.

---

Annual Cost to Federal Government: $1,146,120

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

---

Common Form ICR:  No

---

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: 03/21/2017

---