Appl. for DIC, Death Pension, and/or Accrued Benefits (21P-534EZ); Appl. for Dependency and Indemnity Compensation by a Surviving Spouse or Child; Appl. for Dependency and Indemnity Compensation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 21P-534a Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only	Form	Removed	Available
Form 21P-534a APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	Form	Removed	Repair queued
Form 21P-534 APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	Form and Instruction	Removed	Available
Form 21P-534 APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	Form and Instruction	Removed	Repair queued
Form VA Form 21P-534a Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only	Form	Modified	Repair queued
Form VA Form 21P-534EZ Application for DIC, Survivors Pension, and/or Accrued Benefits	Form	Modified	Repair queued
Form VA Form 21P-534 Application for Dependency and Indemnity Compensation, Survivors Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable)	Form	Modified	Repair queued
Form VA Form 21P-534 APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	Form	Modified	Repair queued
2020-19450.pdf	Supplementary Document	Uploaded 2020-09-03	Repair queued
60-Day FRN (2900-0004).pdf	Supplementary Document	Uploaded 2020-06-12	Repair queued
2900-0004 Supporting Statement (VAF 21P-534, 21P-534a,21P-534EZ) .docx	Supporting Statement A	Uploaded 2020-08-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28073	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	Form	Removed	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only
28073	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	Form	Removed
232907	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	Form and Instruction	Removed	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)
232907	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	Form and Instruction	Removed
232583	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	Form	Modified	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only
232583	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	Form	Modified	Application for DIC, Survivors Pension, and/or Accrued Benefits
232583	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	Form	Modified	Application for Dependency and Indemnity Compensation, Survivors Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable)
232583	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	Form	Modified

ICR Details

OMB Control No: 2900-0004	ICR Reference No: 202005-2900-017
Status: Historical Active	Previous ICR Reference No: 201808-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Appl. for DIC, Death Pension, and/or Accrued Benefits (21P-534EZ); Appl. for Dependency and Indemnity Compensation by a Surviving Spouse or Child; Appl. for Dependency and Indemnity Compensation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/02/2020
Terms of Clearance: In VA's next extension, revision, or extension request, VA shall ensure that these forms include the information required by 5 CFR 1320.8(b)(3) and shall modify Privacy Act statement such as "Your obligation to respond is required to obtain or retain benefits" to more plain language statements such as "Your response is required to obtain or retain benefits."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	36 Months From Approved	10/31/2021
Responses	101,426	0	101,426
Time Burden (Hours)	62,857	0	62,857
Cost Burden (Dollars)	0	0	0

---

Abstract: VA Form 21P-534 is used to gather the necessary information to determine the eligibility of surviving spouses and children for dependency and indemnity compensation (DIC), death pension, accrued benefits, and death compensation. VA Form 21P-534a is an abbreviated application for DIC that is used only by surviving spouses and children of veterans who died while on active duty service. The VA Form 21P-534EZ is used for the Fully Developed Claims (FDC) program for pension claims. Without this information, determination of entitlement would not be possible.

---

Authorizing Statute(s): US Code: 38 USC 1312 Name of Law: Benefits in certain cases of in-service or service-connected deaths
   US Code: 38 USC 1313 Name of Law: Dependency and indemnity compensation to children
   US Code: 38 USC 1532 Name of Law: Surviving spouses of Civil War veterans
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1543 Name of Law: Net worth limitation
   US Code: 38 USC 1310 Name of Law: Deaths entitling survivors to dependency and indemnity compensation
   US Code: 38 USC 1314 Name of Law: Supplemental dependency and indemnity compensation to children
   US Code: 38 USC 1533 Name of Law: Children of Civil War veterans
   US Code: 38 USC 1534 Name of Law: Surviving spouses of Indian War veterans
   US Code: 38 USC 1535 Name of Law: Children of Indian War veterans
   US Code: 38 USC 1536 Name of Law: Surviving spouses of Spanish-American War veterans
   US Code: 38 USC 1537 Name of Law: Children of Spanish-American War veterans
   US Code: 38 USC 1311 Name of Law: Dependency and indemnity compensation to a surviving spouse
   US Code: 38 USC 1542 Name of Law: Children of veterans of a period of war
   US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
   US Code: 38 USC 5101(a) Name of Law: Claims and forms
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 12669	06/12/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 19450	09/03/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY A SURVIVING SPOUSEOR CHILD - IN SERVICE DEATH (VA FORM 21P-534a)	21P-534a	Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD, APPLICATION FOR DIC, SURVIVORS PENSION, AND/OR ACCRUED BENEFITS, AND APPLICATI	VA Form 21P-534, VA Form 21P-534EZ, VA Form 21P-534a	Application for Dependency and Indemnity Compensation, Survivors Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable) ,   Application for DIC, Survivors Pension, and/or Accrued Benefits ,   Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In Service Death Only
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)	21P-534	APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, SURVIVORS PENSION AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (Including Death Compensation if Applicable)

---

ICR Summary of Burden

table that charts list 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	101,426	101,426	0	26,426	-26,426	0
Annual Time Burden (Hours)	62,857	62,857	0	31,607	-31,607	0
Annual Cost Burden (Dollars)	0	0	0	0	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: No

Burden Reduction Due to:

Short Statement: There was no actual burden increase. Each individual form has the same approved burden as the last time it was approved. The only reason it shows in ROCIS as an increase is because the forms are now listed as a bundle versus as individually. We had several forms listed in ROCIS and had to make changes to submit this ICR.

---

Annual Cost to Federal Government: $6,881,132

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? No

---

Common Form ICR:  No

---

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: 10/02/2020

---