Information Collection

Claim for One Sum Payment (Government Life Insurance), VA Form 29-4125, Claim for Monthly Payments (National Service Life Insurance), VA Form 29-4125a, and Claim for Monthly Payments...

IC 28196 under ICR 200805-2900-009 · OMB 2900-0060.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0060 can be found here:

Documents and Forms

Document Name Document Type
Form 29-4125 Claim for One Sum Payment (Government Life Insurance), VA Form 29-4125, Claim for Monthly Payments (National Service Life Insurance), VA Form 29-4125a, and Claim for Monthly Payments... Form
29-4125 Claim for One Sum Payment - Government Life Insurance 29-4125.pdf www.va.gov/vaforms/ Form
29-4125A Claim for Monthly Payments - National Service Life Insur 29-4125a.PDF www.va.gov/vaforms/ Form
29-4125K Claim for Monthly Payments - United States Government Li 29-4125k.PDF www.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claim for One Sum Payment (Government Life Insurance), VA Form 29-4125, Claim for Monthly Payments (National Service Life Insurance), VA Form 29-4125a, and Claim for Monthly Payments...	Agency IC Tracking Number:	2900-0060

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	29-4125	Claim for One Sum Payment - Government Life Insurance	29-4125.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable
Form	29-4125A	Claim for Monthly Payments - National Service Life Insurance	29-4125a.PDF	http://www.va.gov/vaforms/	Yes	No	Fillable Printable
Form	29-4125K	Claim for Monthly Payments - United States Government Life Insurance (USGLI)	29-4125k.PDF	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 84,350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	84,350	84,350
Annual IC Time Burden (Hours)	8,787	8,787
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.