[Federal Register Volume 79, Number 218 (Wednesday, November 12, 2014)]
[Notices]
[Page 67241]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-26719]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0104]


Agency Information Collection (Report of Accidental Injury in 
Support of Claim for Compensation or Pension/Statement of Witness to 
Accident): Activity 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, will submit 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 December 12, 2014.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
[email protected]. Please refer to ``OMB Control No. 2900-
0104'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0104.''

SUPPLEMENTARY INFORMATION:
    Title: Report of Accidental Injury in Support of Claim for 
Compensation or Pension/Statement of Witness to Accident, VA Form 21P-
4176.
    OMB Control Number: 2900-0104.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA Form 21P-4176 is used to support a claim for 
disability benefits based on an accidental injury that a veteran 
incurred while in the line of duty. VA will use the data collected to 
determine whether the injury was accidental or a result of willful 
misconduct by the veteran.
    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 August 28, 2014, at page 51398.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,200 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: One-time.
    Estimated Number of Respondents: 4,400.

    Dated: November 6, 2014.

    By direction of the Secretary.
Crystal Rennie,
Department Clearance Officer, Department of Veterans Affairs.
[FR Doc. 2014-26719 Filed 11-10-14; 8:45 am]
BILLING CODE 8320-01-P