Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits	Form	Modified	Available
Form VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)	Form	Modified	Repair queued
FR 2022-21581_3600449, Correction Notice (VAF21-526EZ).docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
2022-21017, 30-Day FRN (VAF21-526EZ).pdf	Supplementary Document	Uploaded 2022-09-28	Repair queued
2022-14514, 60-Day FRN (VAF21-526EZ).pdf	Supplementary Document	Uploaded 2022-09-22	Repair queued
2900-0747, Supporting Statement (VAF 21-526EZ).docx	Supporting Statement A	Uploaded 2022-09-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191044	Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)	Form	Modified	Application for Disability Compensation and Related Compensation Benefits
191044	Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)	Form	Modified

ICR Details

OMB Control No: 2900-0747	ICR Reference No: 202205-2900-006
Status: Historical Active	Previous ICR Reference No: 201811-2900-001
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/04/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2025	36 Months From Approved	11/30/2022
Responses	2,015,367	0	1,360,000
Time Burden (Hours)	587,815	0	498,667
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-526EZ is used to collect the information needed to process a claim for disability compensation and/or related compensation benefits. The form has evolved over time into a standard claim form to be used for any benefit associated with disability compensation; to include new or initial claims and claims for increase. Without this information, determination of entitlement would not be possible.

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Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Claims and Forms
   PL: Pub.L. 110 - 389 221 Name of Law: Veterans Benefits Improvement Act of 2008
  

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:
	87 FR 40885	07/08/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 58945	09/28/2022
Did the Agency receive public comments on this ICR? Yes

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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
Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ)	VA Form 21-526EZ	Application for Disability Compensation and Related Compensation Benefits

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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	2,015,367	1,360,000	0	655,367	0	0
Annual Time Burden (Hours)	587,815	498,667	0	89,148	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The respondent burden for VA Form 21-526EZ has increased due to: the number of receivables averaged over the past year, general program changes - such as regulatory changes, and the continuing improvement of VA’s electronic claims processing systems.

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Annual Cost to Federal Government: $54,465,928

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: 09/30/2022

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