src/applications/appeals/995/content/OmbInfo.jsx
import React from 'react';
import {
titleFormDetails,
title995Omb,
subTitle995,
title4142Omb,
subTitle4142Omb,
} from './title';
const OmbInfo = () => (
<>
<h2 className="vads-u-margin-top--0">{titleFormDetails}</h2>
<h3>{title995Omb}</h3>
<p>{subTitle995}</p>
<va-omb-info res-burden="15" omb-number="2900-0886" exp-date="4/30/2024">
<p>
<strong>Respondent Burden:</strong> We need this information to
determine entitlement to benefits (38 U.S.C. 501). Title 38, United
States Code, allows us to ask for this information. We estimate that you
will need an average of 15 minutes to review the instructions, find the
information, and complete the form. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is
displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers
can be located on the{' '}
<a
href="https://www.reginfo.gov/public/do/PRAMain"
target="_blank"
rel="noreferrer"
>
OMB Internet Page (opens in a new tab)
</a>
. If desired, you can call <va-telephone contact="8008271000" /> to get
information on where to send comments or suggestions about this form.
</p>
<p>
<strong>Privacy Act Notice:</strong> VA will not disclose information
collected on this form to any source other than what has been authorized
under the Privacy Act of 1974 or title 38, Code of Federal Regulations,
section 1.576 for routine uses (i.e., civil or criminal law enforcement,
congressional communications, epidemiological or research studies, the
collection of money owed to the United States, litigation in which the
United States is a party or has an interest, the administration of VA
programs and delivery of VA benefits, verification of identity and
status, and personnel administration) as identified in the following VA
systems of records published in the Federal Register, 58/VA21/22/28,
Compensation, Pension, Education and Veterans Readiness and Employment
Records -VA; 55VA26 Loan Guaranty Home, Condominium and Manufactured
Home Loan Applicant Records, Specially Adapted Housing Applicant
Records, and Vendee Loan Applicant Records -VA; and 36VA29, Veterans and
Armed Forces Personnel Programs of Government Life Insurance -VA. Your
obligation to respond is required to obtain or retain benefits. VA uses
your SSN to identify your claims file. Providing your SSN will help
ensure that your records are properly associated with your claim file.
Giving us your SSN account information is voluntary. Refusal to provide
your SSN by itself will not result in the denial of benefits. VA will
not deny an individual benefits for refusing to provide his or her SSN
unless the disclosure of the SSN is required by a Federal Statute of law
in effect prior to January 1, 1975, and still in effect. The requested
information is considered relevant and necessary to determine maximum
benefits under the law. The responses you submit are considered
confidential (38 U.S.C. 5701). Information submitted is subject to
verification through computer matching programs with other agencies.
</p>
</va-omb-info>
<h3>{title4142Omb}</h3>
<p>{subTitle4142Omb}</p>
<va-omb-info res-burden="10" omb-number="2900-0858" exp-date="7/31/2024">
<p>
<strong>Respondent Burden:</strong> We need this information and your
written authorization to obtain your treatment records to help us get
the information required to process your claim. Title 38, United States
Code, allows us to ask for this information. You can provide this by
signing VA Form 21-4142. Federal law permits sources with information
about you to release that information if you sign a single authorization
to release all your information from all possible sources. We will make
copies of it for each source. A few States, and some individual sources
of information, require that the authorization specifically name the
source that you authorize to release personal information. In those
cases, we may ask you to sign one authorization for each source and we
may contact you again if we need you to sign more authorizations. We
estimate that you will need an average of 10 minutes to review the
instructions, find the information and complete this form. VA cannot
conduct or sponsor a collection of information unless a valid OMB
control number is displayed. Valid OMB control numbers can be located on
the{' '}
<a
href="https://www.reginfo.gov/public/do/PRAMain"
target="_blank"
rel="noreferrer"
>
OMB Internet Page (opens in a new tab)
</a>
. If desired, you can call <va-telephone contact="8008271000" /> to get
information on where to send comments or suggestions about this form.
</p>
<p>
<strong>Privacy Act Notice:</strong> The VA will not disclose
information collected on this form to any source other than what has
been authorized under the Privacy Act of 1974 or Title 38, Code of
Federal Regulations 1.576 for routine uses (i.e., civil or criminal law
enforcement, congressional communications, epidemiological or research
studies, the collection of money owed to the United States, litigation
in which the United States is a party or has an interest, the
administration of VA programs and delivery of VA benefits, verification
of identity and status, and personnel administration) as identified in
the VA system of records, 58VA21/22/28 Compensation, Pension, Education,
and Veteran Readiness and Employment Records - VA, published in the
Federal Register. Your obligation to respond is voluntary. However, if
the information including your Social Security Number (SSN) is not
furnished completely or accurately, the source to which this
authorization is addressed may not be able to identify and locate your
records, and provide a copy to VA. VA uses your SSN to identify your
claim file. Providing your SSN will help ensure that your records are
properly associated with your claim file. Giving us your SSN account
information is voluntary. Refusal to provide your SSN by itself will not
result in the denial of benefits. The VA will not deny an individual
benefits for refusing to provide his or her SSN unless the disclosure of
the SSN is required by Federal Statute of law in effect prior to January
1, 1975 and still in effect.
</p>
</va-omb-info>
</>
);
export default OmbInfo;