2900-0652, Supporting Statement (VAF 21-0779), 8-7-23

Supporting Statement - Part A

Request for Nursing Home Information in Connection with Claim for Aid and Attendance – Control #2900-0652

Summary of Changes from Previously Approved Collection

• There have been no substantive changes made to this collection.

• The respondent burden has decreased since the previous approval due to the estimated number of receivables averaged over the past year.

1. Need for the Information Collection

The Department of Veterans Affairs (VA) through its Veterans Benefits Administration (VBA) administers an integrated program of benefits and services, established by law, for Veterans, service personnel, and their dependents and/or beneficiaries. Information is requested by VA Form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and Attendance, under the authority of 38 U.S.C. 501(a)(2), 1115(1)(E), 1311(c), 1315(h), 1502, and 5503.

38 U.S.C. 1502 provides for payment of improved pension with aid and attendance to eligible beneficiaries who are patients in nursing home. Parents and surviving spouses entitled to service-connected death benefits and spouses of living veterans receiving service-connected compensation at 30 percent or higher are also entitled to aid and attendance benefits based on status as nursing home patients (38 U.S.C. 1115(1)(E)), 38 U.S.C. 1311(c), 38 U.S.C 1315(h)).

Per 38 U.S.C. 5503, if a veteran having neither spouse nor child, or a surviving spouse having no child, is receiving Medicaid-covered nursing home care, improved pension is limited to $90 per month. Regulatory authority is found in 38 CFR 3.351 and 3.551.

2. Use of the Information

The respondent population for VA Form 21-0779 is composed of individuals who may be entitled to pension and aid and attendance benefits based on nursing home status.

As such, this collection of information is used to gather the necessary information to determine eligibility for pension and aid and attendance benefits based on nursing home status. It also requests information regarding Medicaid status and nursing home care charges, so VA can determine the proper rate of payment.

3. Use of Information Technology

VA Form 21-0779 is available on the One-VA Website in a fillable electronic format. VBA is currently hosting this form on a secure server and does not currently have the technology in place to allow for the complete submission of the form. Validation edits are performed to assure data integrity. There currently is no utility process in place that will allow the data submitted on the form to be incorporated with an existing centralized legacy database.

4. Non-Duplication

The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.

5. Burden on Small Businesses

This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.

6. Less Frequent Collection

Without this collection of information, determination of payment would not be possible.

7. Paperwork Reduction Act Guidelines

This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).

8. Consultation and Public Comments

Part A: PUBLIC NOTICE

A 60-Day Federal Register Notice (FRN) for the collection published on Tuesday, May 30, 2023. The 60-Day FRN citation is 88 FRN 34566. No comments were received during the 60-Day Comment Period.

A 30-Day Federal Register Notice for the collection published on Monday, August 7, 2023. The 30-Day FRN citation is 88 FRN 52259.

Part B: CONSULTATION

No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.

9. Gifts or Payment

No payments or gifts are being offered to respondents as an incentive to participate in the collection.

10. Confidentiality

The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Veteran Readiness and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 on June 19, 2009, and last amended at 87 FR 8740 (February 16, 2022).

11. Sensitive Questions

No questions considered sensitive are being asked in this collection.

12. Respondent Burden and its Labor Costs

1. Number of Respondents is estimated at 17,367 per year.

2. Frequency of Response is one time.

3. Annual burden hours are 2,895 hours.

4. The estimated completion time for each form is 10 minutes.

5. VA cannot make assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA used general wage data to estimate the respondents’ costs associated with completing the information collection.

The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers. According to the latest available BLS data, the mean hourly wage is $29.76 based on the BLS wage code – “00-0000 All Occupations.”  This information was taken from the following website: https://www.bls.gov/oes/current/oes_nat.htm.

Legally, respondents may not pay a person or business for assistance in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $86,155.20 (2,895 burden hours x $29.76 per hour).

13. Respondent Costs Other Than Burden Hour Costs

There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.

14. Costs to the Federal Government

Grade	Step	Burden Time	Fraction of Hour	Hourly Rate	Cost Per Response	Total Responses	Total
7	3	15	0.25	$20.49	5.123	17,367	$ 88,962.46
Overhead at 100% Salary							$ 88,962.46
9	3	10	0.17	$25.06	4.177	17,367	$ 72,536.17
Overhead at 100% Salary							$ 72,536.17
11	3	5	0.08	$30.32	2.527	17,367	$ 43,880.62
Overhead at 100% Salary							$ 43,880.62
Processing / Analyzing Costs							$ 410,758.50
Printing and Production Cost							$ 4,563.98
Total Cost to Government							$ 415,322.48

Overhead costs are 100% of salary and are the same as the wage listed above and the amounts are included in the total. 

Printing and production costs approximates the cost of printing this information collection per year. (Processing/Analyzing Cost total divided by $90).

Note: The hourly wage information above is based on the hourly 2023 General Schedule (Base) Pay (SALARY TABLE 2023-GS (opm.gov)). This rate does not include any locality adjustment as applicable.

The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.

15. Reason for Change in Burden

The burden has decreased since the previous approval due to the estimated number of receivables averaged over the past year.

16. Publication of Results

The results of this information collection will not be published.

17. Non-Display of OMB Expiration Date

We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.

18. Exceptions to “Certification for Paperwork Reduction Submissions”

We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.