Application for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA40-1330 Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery	Form and Instruction	Modified	Repair queued
OMB Justification 2900-0222 (FR) 073121.docx	Supporting Statement A	Uploaded 2021-08-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28470	Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery	Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0222	ICR Reference No: 202108-2900-001
Status: Received in OIRA	Previous ICR Reference No: 202102-2900-013
Agency/Subagency: VA	Agency Tracking No: 2900-0222
Title: Application for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/06/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2024
Responses	166,135	166,135
Time Burden (Hours)	41,534	41,534
Cost Burden (Dollars)	0	0

---

Abstract: VA Form 40-1330 is used by the public to apply for Government-provided headstones or markers for unmarked graves of eligible veterans in accordance with 38 USC 2306. It is the source of information used to evaluate the applicant’s claim for the benefit. The information is requested under 38 CFR 38.632 and represents the minimum requirement by VA to properly determine the veteran’s eligibility for, and entitlement to, this benefit. VA Form 40-1330M is used by the public to apply for Government-provided medallions to be affixed to privately purchased headstones or markers of veterans that died on or after November 1, 1990. It is the source of information used to evaluate the applicant’s claim for the benefit. The information is requested under 38 CFR 38.632 and represents the minimum requirement by VA to properly determine the veteran’s eligibility for, and entitlement to, this benefit.

---

Authorizing Statute(s): US Code: 38 USC Section 2411 Name of Law: The Dignified Burial and Other Veterans' Benefits Improvement Act of 2012
   US Code: 38 USC Section 2306 Name of Law: Headstones, markers, and burial receptacles
   PL: Pub.L. 107 - 103 501 and 502 Name of Law: Government Markers for Marked Graves at Private Cemeteries
   PL: Pub.L. 110 - 157 201 Name of Law: . James Allen Veteran Vision Equity Act of 2007
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 157 201 Name of Law: Blinded Veterans Paired Organs Act of 2007

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ28	Final or interim final rulemaking	86 FR 43091	08/06/2021

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 2093	02/06/2019
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Claim for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery	VA40-1330, VA 40-1330M	Claim For Standard Government Headstone or Marker ,   Claim For Government Medallion For Placement in a Private Cemetery

---

ICR Summary of Burden

table that charts list of burden

	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	166,135	166,135	0	0	0	0
Annual Time Burden (Hours)	41,534	41,534	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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:

---

Annual Cost to Federal Government: $1,240,180

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

---

Common Form ICR:  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:

(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: 08/06/2021

---