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Agency Information Collection (Veteran's Application for Compensation and/or Pension): Activity Under OMB Review

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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.


Comments must be submitted on or before December 24, 2012.


Submit written comments on the collection of information through or 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. 2900-0001” in any correspondence.


Crystal Rennie, Enterprise Records Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 632-7492 Fax (202) 632-7583 or email Please refer to “OMB Control No. 2900-0001.”



a. Veteran's Application for Compensation and/or Pension, VA Form 21-526.

b. Veteran's Supplemental Claim Application, VA Form 21-526b.

c. Authorization and Consent Release Information to the Department of Veterans Affairs (VA), VA Form 21-4142.

OMB Control Number: 2900-0001.

Type of Review: Extension of a currently approved collection.


a. Veterans complete VA Form 21-526 to initially apply for compensation and/or pension benefits.

b. Veterans who previously filed a claim using VA Form 21-526, and who wish to request an increase in a service connected condition, reopen their claim for a previously denied claim, and/or file a claim for a new service-connected condition must complete VA Form 21-526b. VA Form 21-526b will be used for supplemental disability or ancillary benefit claims.

c. Veterans who need VA's assistance in obtaining non-VA medical records must complete VA Form 21-4142.

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 September 13, 2012, at pages 56710-56711.

Affected Public: Individuals or households.

Estimated Annual Burden:

a. VA Form 21-526—391,708.

b. VA Form 21-526b—50,000.

c. VA Form 21-4142—823.

Estimated Average Burden Per Respondent:

a. VA Form 21-526—1 hour.

b. VA Form 21-526b—15 minutes.

b. VA Form 21-4142—5 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents:

a. VA Form 21-526—391,708.

b. VA Form 21-526b—200,000.

c. VA Form 21-4142—3,292.

Dated: November 19, 2012.

By direction of the Secretary.

Robert C. McFetridge,

Director, Office of Regulations Policy and Management, Office of the General Counsel, Department of Veterans Affairs.

[FR Doc. 2012-28445 Filed 11-21-12; 8:45 am]