Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)

ICR 202009-2900-021

OMB: 2900-0094

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
2900-0094 202009-2900-021
Received in OIRA 201709-2900-026
VA VBA-COMP-YA
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)
Reinstatement without change of a previously approved collection   No
Regular 05/24/2021
  Requested Previously Approved
36 Months From Approved
1,000 0
250 0
0 0

VA Form 21-4169 is used to gather information that is necessary to determine eligibility for benefits based on service in the Commonwealth Army of the Philippines or recognized guerrilla organizations, including service information, proof of service, place of residence, and membership in pro-Japanese, pro-German, or anti-American Filipino organizations. Without this information, VA would be unable to properly authorize benefits.

US Code: 38 USC 6104 Name of Law: Forfeiture for treason
   US Code: 38 USC 101 Name of Law: Definitions
  
None

Not associated with rulemaking

  86 FR 13789 03/10/2021
86 FR 26782 05/17/2021
No

  Total Request 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 1,000 0 0 0 0 1,000
Annual Time Burden (Hours) 250 0 0 0 0 250
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$24,423
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/24/2021


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