Application for Veterans Pension (VA Form 21P-527EZ) and Income, Asset, and Employment Statement (VA Form 21P-527)

Forms and Documents

Document Name	Status
Form 21P-527EZ Application for Veterans Pension Form and Instruction	Modified
Form 21P-527 Income, Asset, and Employment Statement Form and Instruction	New
2900-0002 Supporting Statement 20181012.docx Supporting Statement A	2018-10-12

IC Document Collections

IC ID	Document Title	Status
28067	Application for Veterans Pension Form and Instruction	Modified
232906	Income, Asset, and Employment Statement Form and Instruction	New

ICR Details

OMB Control No: 2900-0002	ICR Reference No: 201808-2900-001
Status: Active	Previous ICR Reference No: 201506-2900-003
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Application for Veterans Pension (VA Form 21P-527EZ) and Income, Asset, and Employment Statement (VA Form 21P-527)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/19/2018
	Date Received in OIRA: 09/18/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	36 Months From Approved	04/30/2019
Responses	100,000	0	118,197
Time Burden (Hours)	56,250	0	59,230
Cost Burden (Dollars)	0	0	1,198,223

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Abstract: 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. Title 38 U.S.C. 5101(a) provides that a specific claim in the form provided by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by the Secretary. VA Form 21P-527EZ will be the prescribed form for Veterans Pension applications. In RIN 2900-AO73, VA proposes to amend its pension regulations to maintain the integrity of its needs-based pension program. VA has authority under 38 U.S.C. 501(a) to prescribe all rules and regulations which are necessary or appropriate to carry out the laws administered by VA. VA would amend its information collections in conjunction with RIN 2900-AO73. This rulemaking is largely in response to a Government Accountability Office (GAO) report, GAO-12-50, Veterans’ Pension Benefits: Improvements Needed to Ensure Only Qualified Veterans and Survivors Receive Benefits. VA Form 21P-527EZ, Application for Pension, is the prescribed form for claiming Veterans Pension. VA Form 21P-527EZ is used to gather the necessary information to determine a veteran’s eligibility to Veterans Pension. Without the information, VA will not be able to determine a Veteran’s eligibility to the benefit. VA Form 21P-527, Income, Asset, and Employment Statement (formerly Income, Net Worth and Employment Statement) is another form used to gather necessary information to determine a veteran’s entitlement to Veterans Pension. Veterans use this form to reopen a previously discontinued pension award to reinstate benefits.

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Authorizing Statute(s): US Code: 38 USC 1502 Name of Law: Determinations with respect to disability
   US Code: 38 USC 1503 Name of Law: Determinations with respect to annual income
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO73	Final or interim final rulemaking	83 FR 47246	09/18/2018

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Application for Veterans Pension	21P-527EZ	Application for Veterans Pension
Income, Asset, and Employment Statement	21P-527	Income, Asset, and Employment Statement

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ICR Summary 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	100,000	118,197	0	-18,197	0	0
Annual Time Burden (Hours)	56,250	59,230	0	-2,980	0	0
Annual Cost Burden (Dollars)	0	1,198,223	0	-1,198,223	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The reduction in the number of estimated annual respondents and burden hours was published in the Notice of Proposed Rulemaking 2900-AO73 (80 FR 3839 through 386, on January 23, 2015).

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Annual Cost to Federal Government: $4,337,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 09/18/2018

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