Verification of Eligibility for Burial in a National Cemetery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA-40-4962 Verification of Eligibility for Burial in a National Cemetery	Form	Modified	Available
Description of Changes to VA Form 40-4962 (OMB #2900-0232) 8172022.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-08-19	Available
30-day FRN 2900-0232.pdf	Supplementary Document	Uploaded 2020-08-03	Available
60-day FRN 2900-0232 Verification of Eligibility.pdf	Supplementary Document	Uploaded 2020-06-12	Available
OMB 2900-0232 PRA Collection Justification final 061220_(2-6-20-AS).docx	Supporting Statement A	Uploaded 2020-06-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28474	Verification of Eligibility for Burial in a National Cemetery	Form	Modified

ICR Details

OMB Control No: 2900-0232	ICR Reference No: 202208-2900-013
Status: Active	Previous ICR Reference No: 202006-2900-004
Agency/Subagency: VA	Agency Tracking No:
Title: Verification of Eligibility for Burial in a National Cemetery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/24/2022
	Date Received in OIRA: 08/24/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	11/30/2023	11/30/2023
Responses	135,000	0	135,000
Time Burden (Hours)	33,750	0	33,750
Cost Burden (Dollars)	0	0	0

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Abstract: VA requires applicants for national cemetery burial to provide information to verify eligibility for burial in a national cemetery, to schedule interment and to provide services requested by the decedent’s family or personal representative. This information is also used for planning and scheduling cemetery services and to provide for specific requests from family members or the personal representative.

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Authorizing Statute(s): PL: Pub.L. 103 - 446 509 Name of Law: Center for Minority Veterans and Center for Women Veterans
  

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 28138	05/12/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45961	07/30/2020
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
Verification of Eligibility for Burial in a National Cemetery	VA-40-4962, VA-40-4962	Verification of Eligibility for Burial in a National Cemetery ,   Verification of Eligibility for Burial in a National Cemetery

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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	135,000	135,000	0	0	0	0
Annual Time Burden (Hours)	33,750	33,750	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:

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Annual Cost to Federal Government: $2,614,841

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: 08/24/2022

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