Dependents' Application for VA Education Benefits (Under Provisions of Chapter 33 and 35, Title 38, U.S.C.) (VA Form 22-5490)

Forms and Documents

Document Name	Status
Form VA Form 22-5490 Dependents' Application for VA Education Benefits Form	Modified
Non-Substantive Change for 5490.docx Justification for No Material/Nonsubstantive Change	2020-07-24
White Paper 22-5490.docx Supplementary Document	2018-07-25
2900-0098 SS 5490 10.05.18.docx Supporting Statement A	2018-10-05
2018-12330.pdf Supplementary Document	2018-06-19
2018-03908.pdf Supplementary Document	2018-03-22

IC Document Collections

IC ID	Document Title	Status
28269	Dependents' Application for VA Education Benefits Form	Modified

ICR Details

OMB Control No: 2900-0098	ICR Reference No: 202007-2900-016
Status: Active	Previous ICR Reference No: 201711-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-YA
Title: Dependents' Application for VA Education Benefits (Under Provisions of Chapter 33 and 35, Title 38, U.S.C.) (VA Form 22-5490)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/07/2020
	Date Received in OIRA: 08/06/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021	10/31/2021
Responses	50,981	0	50,981
Time Burden (Hours)	29,740	0	29,740
Cost Burden (Dollars)	0	0	0

---

Abstract: Spouses, surviving spouses, and children of veterans or servicemembers must submit evidence to establish basic eligibility for and entitlement to Survivors' and Dependents' Educational Assistance (DEA) under chapter 35, title 38, U. S. C. VA Form 22-5490 serves as the procedural requirement for these applicants to apply to the Department of Veterans Affairs (VA) for DEA benefits.

---

Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Claims and forms
   US Code: 38 USC 5102 Name of Law: Application forms furnished upon request; notice to claimants of incomplete applications
   US Code: 38 USC 5103 Name of Law: Notice to claimants of required information and evidence
   PL: Pub.L. 113 - 146 701-702 Name of Law: Veterans Access, Choice, and Accountability Act of 2014
   US Code: 38 USC 5113 Name of Law: Effective dates of educational benefits
   US Code: 38 USC 3513 Name of Law: Veterans' Benefits (dependent application)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 3908	02/27/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12330	06/08/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Dependents' Application for VA Education Benefits	VA Form 22-5490, 22-5490	Dependents' Application for VA Education Benefits ,   Dependents' Application for VA Education Benefits

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50,981	50,981	0	0	0	0
Annual Time Burden (Hours)	29,740	29,740	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $408,622

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/06/2020

---