2900-0116, Supporting Statement 8-28-25

Supporting Statement - Part A

Notice to Department of Veterans Affairs of Veteran

or Beneficiary Incarcerated in Penal Institution

Control #2900-0116

Summary of Changes from Previously Approved Collection

• The respondent burden has increased due to the estimated number of receivables averaged over the past year.

• Two public comments received during the comment period.

1. Need for the Information Collection

The Department of Veterans Affairs (VA) through its Veterans Benefits Administration (VBA), administers an integrated program of benefits and services, established by law, for veterans, service personnel and their survivors. Information is requested by VA Form 21-4193, Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution, under the authority of 38 U.S.C. 1505 and 5313. These authorities require reduction or termination of a beneficiary's VA compensation or pension rate when the beneficiary is incarcerated in a penal institution in excess of 60 days after conviction.

2. Use of the Information

The respondent population for VA Form 21-4193 is composed of VA beneficiaries who are incarcerated in penal institutions in excess of 60 days after conviction. The information is needed to determine whether VA benefits should be reduced or terminated based on incarceration of the beneficiary.

3. Use of Information Technology

VA Form 21-4193 is available on the One-VA Website in a fillable electronic format. VBA is currently hosting this form on a secure server and does not currently have the technology in place to allow for the complete submission of the form. Validation edits are performed to assure data integrity. The collection of information does involve the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology.

4. Non-Duplication

The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.

5. Burden on Small Businesses

This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.

6. Less Frequent Collection

VA Form 21-4193 is used to gather the necessary information to determine whether VA benefits should be reduced or terminated based on incarceration of the beneficiary. Without this collection of information, VA would be unable to accurately adjust the rates of incarcerated beneficiaries and overpayments would result.

7. Paperwork Reduction Act Guidelines

This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).

8. Consultation and Public Comments

Part A: PUBLIC NOTICE

A 60-Day Federal Register Notice (FRN) for the collection published on Friday, June 27, 2025. The 60-Day FRN citation is 90 FRN 27758.

Two comments received during the 60-Day comment period. They are included below in the order they were received, as well as our Agency’s response to the comment.

Comment (1):

VBA received a comment from J. Zenner, affiliated with Los Angeles County Department of Military and Veteran Affairs. Comment: Under 38 CFR 3.665, veterans service connection compensation is reduced at the 61st day of their incarceration. While some veterans are able to file an apportionment to have funding go to authorized family members, it is a cumbersome process requiring filling out VA Form 21-0788 and many veterans and their dependents never become aware of the ability to file an apportionment. Successful apportionment sometimes take several months leaving the veteran's dependents in financial hardship. VJOs do not make regular visits to our county jails and state prison in our county. As the County Veteran Service Officer for my county, we do not have the resources to get to all the veterans in our jails. Additionally, many veterans do not want to self identify their veteran status due to shame and fear of losing their benefits. Many dependents of incarcerated veterans face financial hardship at no fault of their own. The service connection dollars that are withheld goes back into the VA general fund. As a result, I recommend that VA consider automating apportionments through a policy change if possible. If it isn't possible, I urge federal legislators to pursue a legislative fix.

VBA Response (1):

As this comment is not relevant to the proposed extension, VBA will not make any changes to VA Form 21-4193. The recommendation to automate claims processing for apportionment has been acknowledged and will be forwarded as appropriate.

Comment (2): VBA received a comment from J. Zenner, affiliated with Los Angeles County Department of Military and Veteran Affairs. Comment: I am the County Veteran Service Officer for Los Angeles County and my VA accredited staff frequently assist veterans who are released from incarceration that struggle to have their benefits reinstated often taking over 30 days. This dynamic creates unnecessary financial hardship on veterans who completed their sentence and their dependents setting our veterans up for unsuccessful re-entry into society. The fix is to automate the process of re-instating VA compensation upon release from incarceration.

VBA Response (2):

As this comment is not relevant to the proposed extension, VBA will not make any changes to VA Form 21-4193. The recommendation to automate claims processing for reinstating VA benefits upon completion of his/her sentence has been acknowledged and will be forwarded as appropriate.

A 30-Day Federal Register Notice for the collection published on Thursday, August 28, 2025. The 30-Day FRN citation is 90 FRN 42065.

Part B: CONSULTATION

No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.

9. Gifts or Payment

No payments or gifts are being offered to respondents as an incentive to participate in the collection.

10. Confidentiality

The records are maintained in the appropriate Privacy Act System of Records identified as “Compensation, Pension, Education, and Veteran Readiness and Employment Records-VA (58VA21/22/28),” published at 74 FR 29275 on June 19, 2009, and last amended at 87 FR 8740 (February 16, 2022).

11. Sensitive Questions

No questions considered sensitive are being asked in this collection.

12. Respondent Burden and its Labor Costs

1. Total number of Respondents is estimated at 9,953 per year.

2. Frequency of Response is one time.

3. Annual burden hours are 2,488 hours.

4. The estimated completion time for this form is 15 minutes.

5. VA cannot make further assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA uses general wage data to estimate the respondents’ costs associated with completing the information collection.

The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers. According to the latest available BLS data, the mean hourly wage is $32.66 based on the BLS wage code – “00-0000 All Occupations.” This information was taken from the following website: https://data.bls.gov/oes/#/industry/000000.

Legally, respondents may not pay a person or business for assistance in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $81,258.08 (2,488 burden hours x $32.66 per hour).

13. Respondent Costs Other Than Burden Hour Costs

There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.

14. Costs to the Federal Government

Grade	Step	Burden Time	Fraction of Hour	Hourly Rate	Cost Per Response	Total Responses	Total
7	3	15	0.25	$21.81	5.453	9,953	$ 54,268.73
Overhead at 100% Salary							$ 54,268.73
9	3	10	0.17	$26.68	4.536	9,953	$ 45,142.83
Overhead at 100% Salary							$ 45,142.83
11	3	5	0.08	$32.28	2.582	9,953	$ 25,702.63
Overhead at 100% Salary							$ 25,702.63
Processing / Analyzing Costs							$250,228.37
Printing and Production Cost							$ 2,780.32
Total Cost to Government							$253,008.69

Overhead costs are 100% of salary and are the same as the wage listed above and the amounts are included in the total. 

Printing and production costs approximates the cost of printing this information collection per year. (Processing/Analyzing Cost total divided by $90).

Note: The hourly wage information above is based on the hourly 2025 General Schedule (Base) Pay (SALARY TABLE 2025-GS). This rate does not include any locality adjustment as applicable.

The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.

15. Reason for Change in Burden

The respondent burden has increased due to the estimated number of receivables averaged over the past year.

16. Publication of Results

The results of this information collection will not be published.

17. Non-Display of OMB Expiration Date

We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.

18. Exceptions to “Certification for Paperwork Reduction Submissions”

We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.