Agency Information Collection Activities; Proposals, Submissions, and Approvals: Employment Questionnaire; OMB No. 0079

Agency Information Collection Activity: Employment Questionnaire

Dates

Written comments and recommendations on the proposed collection of information should be received on or before July 1, 2024.

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: 38 U.S.C. 501, 38 U.S.C. 5317, 38 CFR 3.362 and 3.343, 38 CFR 4.16.

Title: Employment Questionnaire (VA Form 21-4140).

OMB Control Number: 2900-0079.

Type of Review: Revision of a currently approved collection.

Abstract: VA Forms 21-4140 is used to gather the necessary information to determine continued entitlement to individual unemployability. 38 CFR 3.652 provides that recipients are required to certify, when requested, that the eligibility factors which established entitlement to the benefit being paid continue to exist. Individual unemployability is awarded based on a veteran's inability to be gainfully employed due to service-connected disabilities, and entitlement may be terminated if a veteran begins working. Without information about recipients' employment, VA would not be able to determine continued entitlement to individual unemployability, and overpayments would result. No changes have been made to this form. The respondent burden has increased due to the estimated number of receivables averaged over the past year.

Affected Public: Individual or households.

Estimated Annual Burden: 285 hours.

Estimated Average Burden per Respondent: 5 minutes.

Frequency of Response: One time.

Estimated Number of Respondents: 3,422 per year.