Information Collection

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

IC 232583 under ICR 201808-2900-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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-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 %

table that charts list of burden
	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

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.