Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 21-0304 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities	Form	Modified	Available
Form 21-0304 Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)	Form	Modified	Repair queued
2023-02931, 30-Day FRN (VAF21-0304).pdf	Supplementary Document	Uploaded 2023-02-13	Repair queued
2022-26060, 60-Day FRN (VAF21-0304).pdf	Supplementary Document	Uploaded 2023-02-07	Repair queued
2900-0572, Supporting Statement (VAF21-0304).docx	Supporting Statement A	Uploaded 2023-02-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28777	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)	Form	Modified	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities
28777	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)	Form	Modified

ICR Details

OMB Control No: 2900-0572	ICR Reference No: 202211-2900-007
Status: Historical Active	Previous ICR Reference No: 201903-2900-011
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/30/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/13/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	688	0	430
Time Burden (Hours)	115	0	72
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 21-0304 is used to determine the monetary allowance for a child born with Spina Bifida or certain birth defects who is the natural child of a Vietnam and certain Thailand or Korea service veterans. Without this information, VA would be unable to effectively administer 38 U.S.C. 1805, 1815, 1821, and 1822.

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Authorizing Statute(s): US Code: 38 USC Section 1815 Name of Law: Monetary allowance
   US Code: 38 USC Section 1821 Name of Law: Benefits for Children of Certain Korea Service Veterans Born with Spina Bifida
   US Code: 38 USC Section 1822 Name of Law: Benefits for Children of Certain Thailand Service Veterans Born with Spina Bifida
   US Code: 38 USC Section 1805 Name of Law: Monetary allowance
  

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 73585	11/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 9331	02/13/2023
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
Application for Benefits for a Qualifying Veteran's Child Born with Disabilities (VA Form 21-0304)	21-0304	Application for Benefits for a Qualifying Veteran's Child Born with Disabilities

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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	688	430	0	258	0	0
Annual Time Burden (Hours)	115	72	0	43	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 has increased due to the estimated number of receivables averaged over the past year.

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Annual Cost to Federal Government: $23,631

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: 02/13/2023

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