[Federal Register Volume 69, Number 167 (Monday, August 30, 2004)]
[Notices]
[Page 52964]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-19688]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0065]


Agency Information Collection Activities Under OMB Review

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits 
Administration (VBA), Department of Veterans Affairs, has submitted the 
collection of information abstracted below to the Office of Management 
and Budget (OMB) for review and comment. The PRA submission describes 
the nature of the information collection and its expected cost and 
burden; it includes the actual data collection instrument.

DATES: Comments must be submitted on or before September 29, 2004.

FOR FURTHER INFORMATION CONTACT: Denise McLamb, Records Management 
Service (005E3), Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Washington, DC 20420, (202) 273-8030, FAX (202) 273-5981 or e-mail 
[email protected]. Please refer to ``OMB Control No. 2900-
0065.'' Send comments and recommendations concerning any aspect of the 
information collection to VA's OMB Desk Officer, OMB Human Resources 
and Housing Branch, New Executive Office Building, Room 10235, 
Washington, DC 20503, (202) 395-7316. Please refer to ``OMB Control No. 
2900-0065'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Title: Request for Employment Information in Connection with Claim 
for Disability Benefits, VA Form 21-4192.
    OMB Control Number: 2900-0065.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 21-4192 is used to request employment information 
from a claimant's employer. The collected data is used to determine the 
claimant's eligibility for increased disability benefits based on 
unemployability.
    An agency may not conduct or sponsor, and a person is not required 
to respond to a collection of information unless it displays a 
currently valid OMB control number. The Federal Register Notice with a 
60-day comment period soliciting comments on this collection of 
information was published on April 6, 2004, at page 18154.
    Affected Public: Business or other for-profit.
    Estimated Annual Burden: 15,000 hours.
    Estimated Average Burden Per Respondent: 15 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 60,000.

    Dated: August 11, 2004.

    By direction of the Secretary.
Jacqueline Parks,
Program Analyst, Records Management Service.
[FR Doc. 04-19688 Filed 8-27-04; 8:45 am]
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