2900-NEW, Supp Stmt (VAF 21-10210)

OMB #2900-NEW

VA Form #	Title
21-10210	Lay/Witness Statement

1. JUSTIFICATION:

1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.

1. Veteran Ability to Submit Claims Impacted Due to COVID-19: Due to the most recent Novel Coronavirus (COVID-19) pandemic and state of emergency that was declared by the President effective March 1, 2020, the Veterans Benefits Administration (VBA) has taken measures to alter its operations in concert with the Federal Government’s efforts to combat the spread of the virus in the United States population. While the United States Postal Service operations and other mail delivery services continue uninterrupted, in some cases, local travel restrictions and COVID-19-mandated health and safety precautions may impact Veterans’ and claimants’ abilities to file forms, documents, and other responses in connection with VA claims and appeals. VA understands that Veterans and claimants may not submit claims and appeals during this state of emergency.

2. VBA’s Anticipated Increase of Submitted Claims Post COVID-19: Furthermore, VBA anticipates a potential increase in the submission of claims during and after the state of emergency for COVID-19. In an effort to address the effects of COVID-19 on claims processing for Veterans and claimants and to provide better, faster, and more efficient services, VBA proposes to align our modernization efforts with the way we currently receive certain types of Veteran/claimant information. VBA has identified the need for new forms that will reduce the submission of the current free-text form which does not support our current automation processing. This current free-text form does not lend itself to be electronically searched nor is the information able to be more efficiently stored on our computer systems. By creating these new forms that support our existing automation processes, we will be able to provide faster and more efficient delivery of service to Veterans and claimants in response to the anticipated increase in claims-related submissions that were affected by the COVID-19 pandemic.

3. New Forms Enable VBA to Process Veteran Data Faster: VBA proposes the creation of a new form that would better enable VA to receive information from Veterans/claimants more efficiently through our automation processes: lay/witness statements that may support an existing claim or benefits/services. Since no standard form exists for these types of information collections, Veterans, claimants, and Veterans Service Organizations submit such information on a free-text form which requires VA personnel to handle each document individually for processing. With the creation of this new form, VA will be able to utilize computerized optical character recognition, which is the automated process to “read” forms for information upload into our systems.

• VA Form 21-10210, Lay/Witness Statement, will be used to provide lay or witness statements that may support an existing claim for benefits/services. Under the authority of Title 38 U.S.C. 501 Rules and Regulations and Title 38 U.S.C. 5103 Due Process, and Title 38 Code of Federal Regulations (C.F.R.) 3.159 Duty to Assist and Title 38 C.F.R. 3.303 Principles of Service Connection, this form will allow lay or witness statements to be used as evidence that is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. VBA does not have a standard form for claimants to submit a lay or witness statement to support a claim of benefits/services.

2. Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.

VA Form 21-10210 will be used by the claimant to gather lay or witness statements that support an existing claim for benefits/services. Without this information, VA may not be able to efficiently and successfully process claims that may require additional statements associated with a claim for benefits/services.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.

VA Form 21-10210 will be available on the VA Website in a fillable electronic format. VBA will host this form on a secure server and does not currently have the technology in place to allow for the complete submission of the forms. Validation edits are performed to assure data integrity. There currently is no utility process in place that will allow the data submitted on the forms to be incorporated with an existing centralized legacy database.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

Program reviews were conducted to identify potential areas of duplication; however, none were found to exist. There is no known Department or Agency which maintains the necessary information, nor is it available from other sources within our Department.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

The collection of information does not involve small businesses or entities.

6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.

VA Form 21-10210 will be used by the claimant to gather lay or witness statements that support an existing claim for benefits/services. Without this information, VA may not be able to efficiently and successfully process claims that may require additional statements associated with a claim for benefits/services.

7. Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.

There is no special circumstance requiring collection in a manner inconsistent with 5 CFR 1320.6 guidelines.

8. If applicable, provide a copy and identify the date and page number of publications in

the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.

Non-applicable as VA has not published notification in the Federal Register.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No payments or gifts to respondents have been made under this collection of information.

10. Describe any assurance of privacy to the extent permitted by law provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 on June 19, 2009, and last amended at 84 FR 4138 (February 14, 2019).

11. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

12. Estimate of the hour burden of the collection of information:

1. Total Number of Respondents is estimated at 100,000 per year.

2. Frequency of Response is one time.

3. Total Annual burden hours is estimated at 16,667 hours.

4. Average estimated completion time is 10 minutes.

5. The respondent population for VA Form 21-10210 is composed of individuals who are submitting lay or witness statements to support claims for benefits or services. VA cannot make further assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents.  Therefore, VBA used general wage data to estimate the respondents’ costs associated with completing the information collection.

The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers.  According to the latest available BLS data, the mean hourly wage is $25.72 based on the BLS wage code – “00-0000 All Occupations.”  This information was taken from the following website: https://www.bls.gov/oes/current/oes_nat.htm.

Legally, respondents may not pay a person or business for assistance in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $428,675.24 (16,667 burden hours x $25.72 per hour).

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

This submission does not involve any recordkeeping costs.

14. Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

Estimated Costs to the Federal Government:

Grade	Step	Burden Time	Fraction of Hour	Hourly Rate	Cost Per Response	Total Responses	Total
7	3	15	0.25	$19.06	4.765	100,000	$ 476,500.00
Overhead at 100% Salary							$ 476,500.00
9	3	10	0.17	$23.32	3.887	100,000	$ 388,666.67
Overhead at 100% Salary							$ 388,666.67
11	3	5	0.08	$28.21	2.351	100,000	$ 235,083.33
Overhead at 100% Salary							$ 235,083.33
Processing / Analyzing Costs							$ 2,200,500.00
Printing and Production Cost							$ 24,450.00
Total Cost to Government							$ 2,224,950.00

The creation of this form (VA Form 21-10210) is expected to reduce the cost of processing a large portion of the existing VA Form 21-4138, Statement in Support of Claim, which is the form used by claimants and VSOs to submit lay/witness statements.

Overhead costs are 100% of salary and are same as the wage listed above and the amounts are included in the total.

Printing and production costs approximates the cost of printing this information collection per year. (Processing/Analyzing Cost total divided by $90).

Note: The hourly wage information above is based on the hourly 2020 General Schedule (Base) Pay (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2020/GS_h.pdf). This rate does not include any locality adjustment as applicable.

The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.

15. Explain the reason for any burden hour changes since the last submission.

This is a newly created form; therefore, previous burden hour changes do not apply.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

The information collection is not for publication or tabulation use.

17. If seeking approval to omit the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

We are not seeking approval to omit the expiration date for OMB approval.

18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.

This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

No statistical methods are used in this data collection.