Statement of Dependency of Parent(s) (VA Form 21P-509)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 21P-509 Statement of Dependency of Parent(s)	Form	Modified	Available
Form VA Form 21P-509 Statement of Dependency of Parent(s)	Form	Modified	Repair queued
2021-00373.pdf	Supplementary Document	Uploaded 2021-01-25	Repair queued
SupportState(2900-0089).docx	Supporting Statement A	Uploaded 2020-11-05	Repair queued
2020-24305.pdf	Supplementary Document	Uploaded 2020-11-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28244	Statement of Dependency of Parent(s)	Form	Modified	Statement of Dependency of Parent(s)
28244	Statement of Dependency of Parent(s)	Form	Modified

ICR Details

OMB Control No: 2900-0089	ICR Reference No: 202009-2900-025
Status: Historical Active	Previous ICR Reference No: 201708-2900-002
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-NK
Title: Statement of Dependency of Parent(s) (VA Form 21P-509)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/09/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/10/2021
Terms of Clearance: In VA's next revision, extension, or reinstatement request for this collection, VA shall: 1. Have reviewed all related collections (including 21P-509, 21-524, 21P-535) to consider whether there is overlap or duplication, and submit draft updates that ensure that each collection and related instructions indicates when respondents should complete that form versus when there is a different form that should be completing instead based on their circumstances. 2. Consider whether VA imposes any recordkeeping requirements or regularly requires/collects information (such as tax filings) that should be included for PRA approval. The PRA covers collections of information from 10 or more persons through any mechanism, even if not included on a form, but does not include nonstandardized follow-up questions designed to clarify responses to approved collections of information.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2024	36 Months From Approved
Responses	8,000	0	0
Time Burden (Hours)	4,000	0	0
Cost Burden (Dollars)	95,440	0	0

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Abstract: VA Form 21P-0509 Statement of Dependency of Parent(s) is the prescribed form used by VBA to gather income and dependency information from claimants who are seeking payment of benefits as, or for dependent parent(s). VA Form 21P-0509 is used by a Veteran seeking to establish their parent(s) as dependent(s), and by a surviving parent seeking death compensation. This information is used to determine the dependency of the parent and make determinations which affect the payment of monetary benefits to the claimant. Without this information, determination of entitlement would not be possible.

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Authorizing Statute(s): US Code: 38 USC 102 Name of Law: Dependent Parents
   US Code: 38 USC 1315 Name of Law: Dependency and indemnity compensation to parents
   US Code: 38 USC 501 Name of Law: Rules and Regulations
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 24305	11/03/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 373	01/12/2021
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Statement of Dependency of Parent(s)	VA Form 21P-509	Statement of Dependency of Parent(s)

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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	8,000	0	0	0	0	8,000
Annual Time Burden (Hours)	4,000	0	0	0	0	4,000
Annual Cost Burden (Dollars)	95,440	0	0	0	0	95,440

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $468,212

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

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Common Form ICR:  No

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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: 02/10/2021

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