Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

ICR 202009-2900-022

OMB: 2900-0067

Federal Form Document

ICR Details
2900-0067 202009-2900-022
Received in OIRA 201712-2900-004
VA VBA-COMP-MS
Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)
Reinstatement with change of a previously approved collection   No
Regular 06/03/2021
  Requested Previously Approved
36 Months From Approved
1,645 0
411 0
0 0

VA Form 21-4502 is used to gather information that is necessary to determine the entitlement of veterans and servicepersons to automobile and adaptive equipment benefits. Without this information, VA would be unable to properly authorize benefits. The respondent burden has increased due to the estimated number of receivables averaged over the past two years.

US Code: 38 USC 3901 Name of Law: Definitions
   US Code: 38 USC 3903 Name of Law: Limitations on assistance; special training courses
   US Code: 38 USC 3902 Name of Law: Assistance for providing automobile and adaptive equipment
   US Code: 38 USC 3904 Name of Law: Research and development
  
None

Not associated with rulemaking

  86 FR 14800 03/18/2021
86 FR 28685 05/27/2021
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 1,645 0 0 93 0 1,552
Annual Time Burden (Hours) 411 0 0 23 0 388
Annual Cost Burden (Dollars) 0 0 0 -9,312 0 9,312
Yes
Miscellaneous Actions
No
The respondent burden has increased due to the estimated number of receivables averaged over the past two years.

$26,293
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.
06/03/2021


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