82 FR 20687 - Agency Information Collection Activity: Statement in Support of Claim

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 84 (May 3, 2017)

Page Range		20687-20687
FR Document		2017-08933

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 21-4138 is used by claimants to provide self-certified statements in support of various types of claims processed by the agency. VA compensation and pension programs require that statements submitted by or on behalf of a claimant contain certification by the respondent that the information provided is true and correct. This form is designed to facilitate claims processing by providing a uniform format for the certification statement.

Federal Register, Volume 82 Issue 84 (Wednesday, May 3, 2017)

[Federal Register Volume 82, Number 84 (Wednesday, May 3, 2017)]
[Notices]
[Page 20687]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-08933]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0075]


Agency Information Collection Activity: Statement in Support of 
Claim

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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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 21-4138 is used by claimants to provide self-certified 
statements in support of various types of claims processed by the 
agency. VA compensation and pension programs require that statements 
submitted by or on behalf of a claimant contain certification by the 
respondent that the information provided is true and correct. This form 
is designed to facilitate claims processing by providing a uniform 
format for the certification statement.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 3, 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. 2900-0075'' in any correspondence. During the comment period, 
comments may be viewed online through the FDMS.

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

SUPPLEMENTARY INFORMATION: Under the PRA of 1995, 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.
    Authority: Public Law 104-13; 44 U.S.C. 3501-21.
    Title: Statement in Support of Claim, VA Form 21-4138.
    OMB Control Number: 2900-0075.
    Type of Review: Revision of an approved collection.
    Abstract: VA Form 21-4138 is used by claimants to provide self-
certified statements in support of various types of claims processed by 
the agency. VA compensation and pension programs require that 
statements submitted by or on behalf of a claimant contain 
certification by the respondent that the information provided is true 
and correct. This form is designed to facilitate claims processing by 
providing a uniform format for the certification statement.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 188,000.
    Estimated Average Burden per Respondent: 15 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 752,000.

    By direction of the Secretary:
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of 
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-08933 Filed 5-2-17; 8:45 am]
BILLING CODE 8320-01-P

Federal Register / Vol. 82, No. 84 / Wednesday, May 3, 2017 / Notices 20687

Register on Monday, January 23, 2017 collection, and allow 60 days for public Abstract: VA Form 21–4138 is used
that contained an error. The 60-day comment in response to the notice. by claimants to provide self-certified
Public Comment notice identified the VA Form 21–4138 is used by statements in support of various types of
wrong title for the Agency Information claimants to provide self-certified claims processed by the agency. VA
Collection Activity. This document statements in support of various types of compensation and pension programs
serves as Notice for change of the title: claims processed by the agency. VA require that statements submitted by or
‘‘Status of Dependents Questionnaire’’ compensation and pension programs on behalf of a claimant contain
with the revised title: ‘‘Mandatory require that statements submitted by or certification by the respondent that the
Status of Dependents.’’ on behalf of a claimant contain information provided is true and
FOR FURTHER INFORMATION CONTACT: certification by the respondent that the correct. This form is designed to
Cynthia Harvey-Pryor, Enterprise information provided is true and facilitate claims processing by providing
Records Service (005R1B), Department correct. This form is designed to a uniform format for the certification
of Veterans Affairs, 810 Vermont facilitate claims processing by providing statement.
Avenue NW., Washington, DC 20420, at a uniform format for the certification Affected Public: Individuals or
202–461–5870. statement. households.
Estimated Annual Burden: 188,000.
DATES: Written comments and
Correction Estimated Average Burden per
recommendations on the proposed Respondent: 15 minutes.
In FR Doc. 2017–01398, published on collection of information should be Frequency of Response: One time.
Monday, January 23, 2017 at 82 FR 13, received on or before July 3, 2017. Estimated Number of Respondents:
the following was in error. Pages 7917 ADDRESSES: Submit written comments 752,000.
and 7918, displayed ‘‘Agency on the collection of information through By direction of the Secretary:
Information Collection Activity: Status Federal Docket Management System
of Dependents Questionnaire (VA Form Cynthia Harvey-Pryor,
(FDMS) at www.Regulations.gov or to
21–0538),’’ and also under Department Clearance Officer, Enterprise
Nancy J. Kessinger, Veterans Benefits Records Service, Office of Quality and
SUPPLEMENTARY INFORMATION: Title: Administration (20M33), Department of Compliance, Department of Veterans Affairs.
Status of Dependents Questionnaire (VA Veterans Affairs, 810 Vermont Avenue [FR Doc. 2017–08933 Filed 5–2–17; 8:45 am]
Form 21–0538).’’ Publication of the 30- NW., Washington, DC 20420 or email to
day Federal Register Notice comment BILLING CODE 8320–01–P
nancy.kessinger@va.gov. Please refer to
period will display the revised titles: ‘‘OMB Control No. 2900–0075’’ in any
Agency Information Collection Activity: correspondence. During the comment DEPARTMENT OF VETERANS
Mandatory Status of Dependents period, comments may be viewed online AFFAIRS
SUPPLEMENTARY INFORMATION: Title: through the FDMS.
Mandatory Status of Dependents.’’ FOR FURTHER INFORMATION CONTACT:
[OMB Control No. 2900–0500]
Dated: April 26, 2017. Nancy J. Kessinger at (202) 632–8924 or Agency Information Collection Activity
By direction of the Secretary. FAX (202) 632–8925. Under OMB Review: Mandatory Status
Cynthia Harvey-Pryor, SUPPLEMENTARY INFORMATION: Under the of Dependents
Department Clearance Officer, Enterprise PRA of 1995, Federal agencies must
Records Service, Office of Quality and obtain approval from the Office of AGENCY: Veterans Benefits
Compliance, Department of Veterans Affairs. Management and Budget (OMB) for each Administration, Department of Veterans
[FR Doc. 2017–08929 Filed 5–2–17; 8:45 am] collection of information they conduct Affairs.
BILLING CODE 8320–01–P or sponsor. This request for comment is ACTION: Notice.
being made pursuant to Section
SUMMARY: In compliance with the
3506(c)(2)(A) of the PRA.
With respect to the following Paperwork Reduction Act (PRA) of
DEPARTMENT OF VETERANS
collection of information, VBA invites 1995, this notice announces that the
AFFAIRS
comments on: (1) Whether the proposed Veterans Benefits Administration,
Department of Veterans Affairs, will
[OMB Control No. 2900–0075] collection of information is necessary
submit the collection of information
for the proper performance of VBA’s
abstracted below to the Office of
Agency Information Collection functions, including whether the
Management and Budget (OMB) for
Activity: Statement in Support of Claim information will have practical utility;
review and comment. The PRA
(2) the accuracy of VBA’s estimate of the
AGENCY: Veterans Benefits submission describes the nature of the
burden of the proposed collection of
Administration, Department of Veterans information collection and its expected
information; (3) ways to enhance the
Affairs. cost and burden and it includes the
quality, utility, and clarity of the
actual data collection instrument.
ACTION: Notice. information to be collected; and (4)
DATES: Comments must be submitted on
ways to minimize the burden of the
SUMMARY: The Veterans Benefits collection of information on or before June 2, 2017.
Administration (VBA), Department of respondents, including through the use ADDRESSES: Submit written comments
Veterans Affairs (VA), is announcing an of automated collection techniques or on the collection of information through
opportunity for public comment on the the use of other forms of information www.Regulations.gov, or to Office of
proposed collection of certain technology. Information and Regulatory Affairs,
nlaroche on DSK30NT082PROD with NOTICES

information by the agency. Under the Authority: Public Law 104–13; 44 Office of Management and Budget, Attn:
Paperwork Reduction Act (PRA) of U.S.C. 3501–21. VA Desk Officer; 725 17th St. NW.,
1995, Federal agencies are required to Title: Statement in Support of Claim, Washington, DC 20503 or sent through
publish notice in the Federal Register VA Form 21–4138. electronic mail to oira_submission@
concerning each proposed collection of OMB Control Number: 2900–0075. omb.eop.gov. Please refer to ‘‘OMB
information, including each proposed Type of Review: Revision of an Control No. 2900–0500’’ in any
revision of a currently approved approved collection. correspondence.

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Document Created: 2018-11-08 08:36:56
Document Modified: 2018-11-08 08:36:56

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice.
Dates		Written comments and recommendations on the proposed collection of information should be received on or before July 3, 2017.
Contact		Nancy J. Kessinger at (202) 632-8924 or FAX (202) 632-8925.
FR Citation		82 FR 20687