Information Collection

Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)

IC 28078 under ICR 201708-2900-010 · OMB 2900-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0005 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21P-535 Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)	Form and Instruction
21P-535 Application for Dependency and Indemnity Compensation by 2900-0005 21P-535 Approved Version.pdf www.vba.va.gov/pubs/forms/VBA-21P-535-ARE.pdf	Form and Instruction

IC Title:

Application for DIC by Parent(s) (Including Accrued Benefits and Death Compensation)

Agency IC Tracking Number:

2900-0005

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 and Instruction	21P-535	Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation when Applicable)	2900-0005 21P-535 Approved Version.pdf	https://www.vba.va.gov/pubs/forms/VBA-21P-535-ARE.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title: 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA

FR Citation: 77 FR 42593

Number of Respondents: 3,600

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,600	0	3,600
Annual IC Time Burden (Hours)	4,320	0	4,320
Annual IC Cost Burden (Dollars)	103,068	-612	103,680

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.