Information Collection

Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance

IC 28196 under ICR 201009-2900-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 29-4125 Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance	Form
29-4125 Claim for One Sum Payment - Government Life Insurance VA Form 29-4125.pdf www.va.gov/vaforms/	Form
29-4125A Claim for Monthly Payments - National Service Life Insur VA Form 29-4125a.pdf www.va.gov/vaforms/	Form
29-4125K Claim for Monthly Payments - United States Government Li VA Form 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), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance

Agency IC Tracking Number:

2900-0060

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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	VA Form 29-4125.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable
Form	29-4125A	Claim for Monthly Payments - National Service Life Insurance	VA Form 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)	VA Form 29-4125k.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	84,350	0	84,350
Annual IC Time Burden (Hours)	8,510	-277	8,787
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.