Application For Dic, Survivors Pension, And/or Accrued Benefits

Application for DIC, Death Pension, and/or Accrued Benefits; Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child; Application for Dependency and Indemnity Compensation

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 21P-534EZ APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS Form and Instruction
21P-534EZ Application for DIC, Survivors Pension, and/or Accrued B 2900-0004 21P-534EZ(12-22-14).pdf www.vba.va.gov/pubs/forms/VBA-21P-534EZ-ARE.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS	Agency IC Tracking Number:	2900-0004

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.271 38 CFR 3.5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	21P-534EZ	Application for DIC, Survivors Pension, and/or Accrued Benefits	2900-0004 21P-534EZ(12-22-14).pdf	https://www.vba.va.gov/pubs/forms/VBA-21P-534EZ-ARE.pdf	Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28)	FR Citation: 77 FR 42593

Number of Respondents: 75,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75,000	75,000
Annual IC Time Burden (Hours)	31,250	31,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.