82_FR_12959 82 FR 12916 - Agency Information Collection Activity: Statement of Marital Relationship (VA Form 21-4170)

82 FR 12916 - Agency Information Collection Activity: Statement of Marital Relationship (VA Form 21-4170)

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 43 (March 7, 2017)

Page Range12916-12917
FR Document2017-04349

The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed revision of a currently approved collection, and allow 60 days for public comment in response to the notice. VA Form 21-4170 is used to gather information that is necessary to determine whether a valid common law marriage was established. The form is used by persons claiming to be common law widows/widowers of deceased veterans and by veterans and their claimed common law spouses. Benefits cannot be authorized unless a valid marriage is established.

Federal Register, Volume 82 Issue 43 (Tuesday, March 7, 2017) 
[Federal Register Volume 82, Number 43 (Tuesday, March 7, 2017)]
[Notices]
[Pages 12916-12917]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-04349]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0114]


Agency Information Collection Activity: Statement of Marital 
Relationship (VA Form 21-4170)

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Veterans Benefits Administration (VBA), Department of 
Veterans Affairs (VA), is announcing an opportunity for public comment 
on the proposed collection of certain information by the agency. Under 
the Paperwork Reduction Act (PRA) of 1995, Federal agencies are 
required to publish notice in the Federal Register concerning each 
proposed collection of information, including each proposed revision of 
a currently approved collection, and allow 60 days for public comment 
in response to the notice.
    VA Form 21-4170 is used to gather information that is necessary to 
determine whether a valid common law marriage was established. The form 
is used by persons claiming to be common law widows/widowers of 
deceased veterans and by veterans and their claimed common law spouses. 
Benefits cannot be authorized unless a valid marriage is established.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before May 8, 2017.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420 or email to [email protected]. Please refer to ``OMB Control 
No. 2900-0114'' in any correspondence. During the comment period, 
comments may be viewed online through the FDMS.

[[Page 12917]]


FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 
or FAX (202) 632-8925.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501--21), Federal agencies must obtain approval from the Office 
of Management and Budget (OMB) for each collection of information they 
conduct or sponsor. This request for comment is being made pursuant to 
Section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VBA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VBA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VBA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Title: Statement of Marital Relationship (VA Form 21-4170).
    OMB Control Number: 2900-0114.
    Type of Review: Revision of an approved collection.
    Abstract: VA Form 21-4170 is used to gather information that is 
necessary to determine whether a valid common law marriage was 
established. The form is used by persons claiming to be common law 
widows/widowers of deceased veterans and by veterans and their claimed 
common law spouses. Benefits cannot be authorized unless a valid 
marriage is established.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,708 hours.
    Estimated Average Burden per Respondent: 25 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 6,500.

    By direction of the Secretary.
Cynthia Harvey-Pryor
Department Clearance Officer, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-04349 Filed 3-6-17; 8:45 am]
 BILLING CODE 8320-01-P

12916 Federal Register / Vol. 82, No. 43 / Tuesday, March 7, 2017 / Notices not living together, or (2) an unmarried For each $1 of annual income which Department of Veterans Affairs, parent when both parents are living and is more than $3,200 but not more than approved this document on February the other parent has remarried. The $7,087, the monthly rate shall be 16, 2017, for publication. monthly rate of DIC paid to each such reduced by $0.08. Dated: February 16, 2017. parent shall be $450 reduced on the For each $1 of annual income which Jeffrey Martin, basis of each parent’s annual income, is more than $7,087 but not more than Office Program Manager, Office of Regulation according to the following formula: $7,088, the monthly rate shall be Policy & Management, Office of the Secretary, For each $1 of annual income which reduced by $0.04. Department of Veterans Affairs. is more than $0 but not more than $800, For each $1 of annual income which [FR Doc. 2017–04356 Filed 3–6–17; 8:45 a.m.] the $450 monthly rate shall not be is more than $7,088, the monthly rate BILLING CODE 8320–01–P reduced. shall not be reduced. For each $1 of annual income which No Parents’ DIC is payable if the is more than $800 but not more than annual income exceeds $19,733. DEPARTMENT OF VETERANS $900, the monthly rate shall be reduced These rates are also applicable in the AFFAIRS by $0.06. case of one surviving parent who has For each $1 of annual income which remarried, computed on the basis of the combined income of the parent and [OMB Control No. 2900–0114] is more than $900 but not more than $1,100, the monthly rate shall be spouse, if this would be a greater benefit Agency Information Collection reduced by $0.07. than that specified in Table 2 for one Activity: Statement of Marital For each $1 of annual income which parent. Aid and attendance: The monthly rate Relationship (VA Form 21–4170) is more than $1,100 but not more than $6,412, the monthly rate shall be of DIC payable to a parent under Tables AGENCY: Veterans Benefits reduced by $0.08. 2 through 4 shall be increased by $337 Administration, Department of Veterans For each $1 of annual income more if such parent is (1) a patient in a Affairs. than $6,412 but not more than $6,413, nursing home, or (2) helpless or blind, or so nearly helpless or blind as to need ACTION: Notice. the monthly rate shall be reduced by $0.04. or require the regular aid and attendance of another person. SUMMARY: The Veterans Benefits For each $1 of annual income which Administration (VBA), Department of is more than $6,413, the monthly rate Minimum rate: The monthly rate of DIC payable to any parent under Tables Veterans Affairs (VA), is announcing an shall not be reduced. opportunity for public comment on the No Parents’ DIC is payable under this 2 through 4 shall not be less than $5. proposed collection of certain table if annual income exceeds $14,680. Section 306 Pension Income Limitations information by the agency. Under the One of two parents living with spouse Paperwork Reduction Act (PRA) of Veteran or surviving spouse with no or other parent (38 U.S.C. 1315(d)): The 1995, Federal agencies are required to dependents, $14,680 (Pub. L. 95–588, rates below apply to each parent living publish notice in the Federal Register section 306(a)) with another parent; and each remarried Veteran in need of aid and attendance concerning each proposed collection of parent, when both parents are alive. The with no dependents, $15,208 (38 U.S.C. information, including each proposed monthly rate of DIC paid to such parents 1521(d) as in effect on December 31, revision of a currently approved will be $423 reduced on the basis of the 1978 collection, and allow 60 days for public combined annual income of the two Veteran or surviving spouse with one comment in response to the notice. parents living together or the remarried or more dependents, $19,733 (Pub. L. VA Form 21–4170 is used to gather parent or parents and spouse or spouses, 95–588, section 306(a)) information that is necessary to as computed under the following Veteran in need of aid and attendance determine whether a valid common law formula: with one or more dependents, $20,260 marriage was established. The form is For each $1 of annual income which (38 U.S.C. 1521(d) as in effect on used by persons claiming to be common is more than $0 but not more than December 31, 1978) law widows/widowers of deceased $1,000, the $423 monthly rate shall not Child (no entitled veteran or surviving veterans and by veterans and their be reduced. spouse), $12,003 (Pub. L. 95–588, claimed common law spouses. Benefits For each $1 of annual income which section 306(a)) cannot be authorized unless a valid is more than $1,000 but not more than Spouse income exclusion (38 CFR marriage is established. $1,500, the monthly rate shall be 3.262), $4,688 (Pub. L. 95–588, section reduced by $0.03. DATES: Written comments and 306(a)(2)(B)) recommendations on the proposed For each $1 of annual income which is more than $1,500 but not more than Old-Law Pension Income Limitations collection of information should be $1,900, the monthly rate shall be Veteran or surviving spouse without received on or before May 8, 2017. reduced by $0.04. dependents or an entitled child, $12,854 ADDRESSES: Submit written comments For each $1 of annual income which (Pub. L. 95–588, section 306(b)) on the collection of information through is more than $1,900 but not more than Veteran or surviving spouse with one Federal Docket Management System $2,400, the monthly rate shall be or more dependents, $18,528 (Pub. L. (FDMS) at www.Regulations.gov or to reduced by $0.05. 95–588, section 306(b)) Nancy J. Kessinger, Veterans Benefits For each $1 of annual income which The Secretary of Veterans Affairs, or Administration (20M33), Department of sradovich on DSK3GMQ082PROD with NOTICES is more than $2,400 but not more than designee, approved this document and Veterans Affairs, 810 Vermont Avenue $2,900, the monthly rate shall be authorized the undersigned to sign and NW., Washington, DC 20420 or email to reduced by $0.06. submit the document to the Office of the nancy.kessinger@va.gov. Please refer to For each $1 of annual income which Federal Register for publication ‘‘OMB Control No. 2900–0114’’ in any is more than $2,900 but not more than electronically as an official document of correspondence. During the comment $3,200, the monthly rate shall be the Department of Veterans Affairs. Gina period, comments may be viewed online reduced by $0.07. S. Farrisee, Deputy Chief of Staff, through the FDMS. VerDate Sep<11>2014 16:01 Mar 06, 2017 Jkt 241001 PO 00000 Frm 00135 Fmt 4703 Sfmt 4703 E:\FR\FM\07MRN1.SGM 07MRN1

Federal Register / Vol. 82, No. 43 / Tuesday, March 7, 2017 / Notices 12917 FOR FURTHER INFORMATION CONTACT: DEPARTMENT OF VETERANS soliciting comments on this collection Nancy J. Kessinger at (202) 632–8924 or AFFAIRS of information was published at Vol. 81, FAX (202) 632–8925. No. 249, Wednesday, December 28, [OMB Control No. 2900–0811] 2016, page 95735. SUPPLEMENTARY INFORMATION: Under the Affected Public: Individuals or PRA of 1995 (Pub. L. 104–13; 44 U.S.C. Agency Information Collection Activity Households. 3501—21), Federal agencies must obtain Under OMB Review: (Hip and Thigh Estimated Annual Burden: 25,000. approval from the Office of Management Conditions Disability Benefits Estimated Average Burden per and Budget (OMB) for each collection of Questionnaire (VA Form 21–0960M–8) Respondent: 30 minutes. information they conduct or sponsor. AGENCY: Veterans Benefits Frequency of Response: One time. This request for comment is being made Administration, Department of Veterans Estimated Number of Respondents: pursuant to Section 3506(c)(2)(A) of the Affairs. 50,000. PRA. ACTION: Notice. By direction of the Secretary. With respect to the following Cynthia Harvey-Pryor, collection of information, VBA invites SUMMARY: In compliance with the Department Clearance Officer, Office of comments on: (1) Whether the proposed Paperwork Reduction Act (PRA) of Privacy and Records Management, collection of information is necessary 1995, this notice announces that the Department of Veterans Affairs. for the proper performance of VBA’s Veterans Benefits Administration, [FR Doc. 2017–04425 Filed 3–6–17; 8:45 am] functions, including whether the Department of Veterans Affairs, will BILLING CODE 8320–01–P submit the collection of information information will have practical utility; abstracted below to the Office of (2) the accuracy of VBA’s estimate of the Management and Budget (OMB) for DEPARTMENT OF VETERANS burden of the proposed collection of review and comment. The PRA AFFAIRS information; (3) ways to enhance the submission describes the nature of the quality, utility, and clarity of the [OMB Control No. 2900–0215] information collection and its expected information to be collected; and (4) cost and burden and it includes the Agency Information Collection Activity ways to minimize the burden of the actual data collection instrument. Under OMB Review: Request for collection of information on DATES: Comments must be submitted on Information To Make Direct Payment to respondents, including through the use or before April 6, 2017. Child Reaching Majority of automated collection techniques or ADDRESSES: Submit written comments AGENCY: Veterans Benefits the use of other forms of information on the collection of information through Administration, Department of Veterans technology. www.Regulations.gov, or to Office of Affairs (VA). Title: Statement of Marital Information and Regulatory Affairs, Relationship (VA Form 21–4170). ACTION: Notice. Office of Management and Budget, Attn: OMB Control Number: 2900–0114. VA Desk Officer; 725 17th Street NW., SUMMARY: In compliance with the Washington, DC 20503 or sent through Paperwork Reduction Act (PRA) of Type of Review: Revision of an electronic mail to oira_submission@ 1995, this notice announces that the approved collection. omb.eop.gov. Please refer to ‘‘OMB Veterans Benefits Administration, Abstract: VA Form 21–4170 is used to Control No. 2900–0811’’ in any Department of Veterans Affairs, will gather information that is necessary to correspondence. submit the collection of information determine whether a valid common law FOR FURTHER INFORMATION CONTACT: abstracted below to the Office of marriage was established. The form is Cynthia Harvey-Pryor, Enterprise Management and Budget (OMB) for used by persons claiming to be common Records Service (005R1B), Department review and comment. The PRA law widows/widowers of deceased of Veterans Affairs, 810 Vermont submission describes the nature of the veterans and by veterans and their Avenue NW., Washington, DC 20420, information collection and its expected claimed common law spouses. Benefits (202) 461–5870 or email cynthia.harvey- cost and burden and it includes the cannot be authorized unless a valid pryor@va.gov. Please refer to ‘‘OMB actual data collection instrument. marriage is established. Control No. 2900–0811’’ in any DATES: Comments must be submitted on Affected Public: Individuals or correspondence. or before April 6, 2017. households. SUPPLEMENTARY INFORMATION: ADDRESSES: Submit written comments Title: Hip and Thigh Conditions on the collection of information through Estimated Annual Burden: 2,708 Disability Benefits Questionnaire (VA www.Regulations.gov, or to Office of hours. Form 21–0960M–8). Information and Regulatory Affairs, Estimated Average Burden per Office of Management and Budget, Attn: OMB Control Number: 2900–0811. Respondent: 25 minutes. VA Desk Officer; 725 17th St. NW., Type of Review: Extension of a Frequency of Response: One time. currently approved collection. Washington, DC 20503 or sent through Abstract: VA Forms 21–0960M–8 is electronic mail to oira_submission@ Estimated Number of Respondents: used to gather necessary information omb.eop.gov. Please refer to ‘‘OMB 6,500. from a claimant’s treating physician Control No. 2900–0215’’ in any By direction of the Secretary. correspondence. regarding the results of medical sradovich on DSK3GMQ082PROD with NOTICES Cynthia Harvey-Pryor examinations. FOR FURTHER INFORMATION CONTACT: Department Clearance Officer, Office of An agency may not conduct or Cynthia Harvey-Pryor, Enterprise Privacy and Records Management, sponsor, and a person is not required to Records Service (005R1B), Department Department of Veterans Affairs. respond to a collection of information of Veterans Affairs, 810 Vermont [FR Doc. 2017–04349 Filed 3–6–17; 8:45 am] unless it displays a currently valid OMB Avenue NW., Washington, DC 20420, BILLING CODE 8320–01–P control number. The Federal Register (202) 461–5870 or email cynthia.harvey- Notice with a 60-day comment period pryor@va.gov. Please refer to ‘‘OMB VerDate Sep<11>2014 16:01 Mar 06, 2017 Jkt 241001 PO 00000 Frm 00136 Fmt 4703 Sfmt 4703 E:\FR\FM\07MRN1.SGM 07MRN1


Document Created: 2018-02-01 14:49:05
Document Modified: 2018-02-01 14:49:05
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesWritten comments and recommendations on the proposed collection of information should be received on or before May 8, 2017.
ContactNancy J. Kessinger at (202) 632-8924 or FAX (202) 632-8925.
FR Citation82 FR 12916 
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