Information Collection

APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)

IC 28073 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⚠️ Notice: This information collection may be referencing outdated material.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-534a APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	Form
21P-534a Application for Dependency and Indemnity Compensation by 2900-0004 21P-534a (1-10-18) OMB Expiring.pdf www.vba.va.gov/pubs/forms/VBA-21P-534a-ARE.pdf	Form

IC Title:

APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)

Agency IC Tracking Number:

2900-0004

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 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	21P-534a	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only	2900-0004 21P-534a (1-10-18) OMB Expiring.pdf	https://www.vba.va.gov/pubs/forms/VBA-21P-534a-ARE.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

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: 1,426

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	1,426	-113,574	115,000
Annual IC Time Burden (Hours)	357	-68,734	69,091
Annual IC Cost Burden (Dollars)	0	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.