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

ICR 202009-2900-025

OMB: 2900-0089

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-01-25
Supporting Statement A
2020-11-05
Supplementary Document
2020-11-05
IC Document Collections
IC ID
Document
Title
Status
28244 Modified
ICR Details
2900-0089 202009-2900-025
Received in OIRA 201708-2900-002
VA VBA-P&F-NK
Statement of Dependency of Parent(s) (VA Form 21P-509)
Reinstatement with change of a previously approved collection   No
Regular 02/10/2021
  Requested Previously Approved
36 Months From Approved
8,000 0
4,000 0
95,440 0

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.

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
  
None

Not associated with rulemaking

  85 FR 24305 11/03/2020
86 FR 373 01/12/2021
No

1
IC Title Form No. Form Name
Statement of Dependency of Parent(s) VA Form 21P-509 Statement of Dependency of Parent(s)

  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 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
No
No

$468,212
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.
02/10/2021


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