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Proposed Information Collection Activity: Proposed Collection; Comment Request

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Information about this document as published in the Federal Register.

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Veterans Benefits Administration, Department of Veterans Affairs.




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 new collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on information needed to obtain evidence to substantiate claims for service connection post-traumatic stress disorder (PTSD).


Written comments and recommendations on the proposed collection of information should be received on or before January 31, 2005.


Submit written comments on the collection of information to Nancy J. Kessinger, Veterans Benefits Administration (20M35), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-mail Please refer to “OMB Control No. 2900-New” in any correspondence.

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Nancy J. Kessinger at 9202) 273-7079 or fax (202) 275-5947.

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Under the PRA of 1995 (Pub. L. 104-13; 44 U.S.C. 3501-3521), 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.


a. Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD), VA Form 21-0781.

b. Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault, VA Form 21-0781a.

OMB Control Number: 2900-New.

Type of Review: New Collection.

Abstract: VA Forms 21-0781 and 21-0781a are used to assist claimants in obtaining evidence to substantiate their claims of in-service stressors. When a veteran who did not serve in combat or was not a prisoner of war claims post-traumatic stress disorder due to in-service stressors, there must be credible supporting evidence that the claimed stressors occurred. The claimant must provide a medical diagnosis; a link established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service strssor occurred.

Affected Public: Individuals or households.

Estimated Annual Burden: 17,780 hours.

Estimated Average Burden Per Respondent: 70 minutes.

Frequency of Response: One-time.

Estimated Number of Respondents: 15,240.

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Dated: November 22, 2004.

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By direction of the Secretary.

Loise Russell,

Director, Records Management Service.

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[FR Doc. 04-26461 Filed 11-30-04; 8:45 am]