This PDF is the current document as it appeared on Public Inspection on 08/21/2014 at 08:45 am.
Veterans Benefits Administration, Department of Veterans Affairs.
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 September 22, 2014.
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@example.com. Please refer to “OMB Control No. 2900-0665” in any correspondence. During the comment period, comments may be viewed online through the FDMS.Start Further Info
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 firstname.lastname@example.org. Please refer to “OMB Control No. 2900-0665” in any correspondence.End Further Info End Preamble Start Supplemental 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: Revision 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 May 30, 2014, at pages 31182-31183 .
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.Start Signature
Dated: August 19, 2014.
By direction of the Secretary.
VA Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2014-19996 Filed 8-21-14; 8:45 am]
BILLING CODE 8320-01-P