Application for Exclusion of Children's Income (VA Form 21P-0571)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 21P-0571 Application for Exclusion of Children's Income	Form	Modified	Available
Form VA Form 21P-0571 Application for Exclusion of Children's Income	Form	Modified	Available
Form VA Form 21P-0571 Application for Exclusion of Children's Income (21P-0571)	Form	Modified	Repair queued
30-Day FRN - 2900-0510 (2024).pdf	Supplementary Document	Uploaded 2024-04-15	Repair queued
2900-0510 Suppporting Statement (21P-0571).docx	Supporting Statement A	Uploaded 2024-04-15	Repair queued
60-Day FRN (published).pdf	Supplementary Document	Uploaded 2024-02-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28698	Application for Exclusion of Children's Income (21P-0571)	Form	Modified	Application for Exclusion of Children's Income
28698	Application for Exclusion of Children's Income (21P-0571)	Form	Modified	Application for Exclusion of Children's Income
28698	Application for Exclusion of Children's Income (21P-0571)	Form	Modified

ICR Details

OMB Control No: 2900-0510	ICR Reference No: 202401-2900-012
Status: Active	Previous ICR Reference No: 202103-2900-004
Agency/Subagency: VA	Agency Tracking No: VBA-P&F-YA
Title: Application for Exclusion of Children's Income (VA Form 21P-0571)
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: 05/22/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/15/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	06/30/2024
Responses	45	0	2,700
Time Burden (Hours)	32	0	2,025
Cost Burden (Dollars)	0	0	0

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Abstract: 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. A Veteran’s or Surviving Spouse’s rate of “Improved Pension” is determined by family income. Generally, the income of children who are members of the household is included in this determination. However, children’s income may be excluded if it is unavailable or if consideration of that income would cause hardship. 38 U.S.C. 1521(h) and 1541(g) provide the authority for the exclusion of children’s income based on unavailability or hardship. VA Form 21P-0571 is the prescribed form used by VBA to adequately evaluate children’s income for possible exclusion from the calculation of total family income.

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Authorizing Statute(s): US Code: 38 USC 1521 Name of Law: Veterans of a period of war
   US Code: 38 USC 1541 Name of Law: Surviving spouses of veterans of a period of war
  

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:
	89 FR 8277	02/06/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 26215	04/15/2024
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 Exclusion of Children's Income (21P-0571)	VA Form 21P-0571, 21P-0571	Application for Exclusion of Children's Income ,   Application for Exclusion of Children's Income

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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	45	2,700	0	-2,655	0	0
Annual Time Burden (Hours)	32	2,025	0	-1,993	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: No changes have been made to this form. The respondent burden has decreased due to the estimated number of receivables averaged over the past year.

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Annual Cost to Federal Government: $2,888

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: 04/15/2024

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