[Federal Register Volume 82, Number 84 (Wednesday, May 3, 2017)]
[Notices]
[Page 20687]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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]
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