2900-0016 justification

SUPPORTING STATEMENT

VA FORM 29-357

CLAIM FOR DISABILITY INSURANCE BENEFITS

2900-0016

JUSTIFICATION:

1. This form is used by the policyholder to claim disability insurance benefits on NSLI and USGLI policies. The information requested is authorized by law, 38 U.S.C. sections 1912, 1915, 1942 and 1948.

2. The information collected on the form is used by Department of Veterans Affairs (VA) to establish the insured’s eligibility for disability insurance benefits. This application is to be completed by veterans who have government life insurance and become totally disabled.

3. VA Form 29-357 has been added to our VBA website for downloading. The insured is now able to complete the form electronically, print and submit the claim by mail.

4. The information is not contained in any other VA records. Similar information is not available elsewhere.

5. The information does not involve any small businesses.

6. This form is designed for use by the insurance activity to determine the insured’s eligibility for disability insurance benefits.

7. There are no special circumstances requiring that the collection of information be conducted in a manner inconsistent with the guidelines in 5 CFR Section 1320.6.

8. The Department notice was published in the Federal Register on September 13, 2011, at pages 56504-56505. There were no comments received in response to this notice.

9. The information collected is supplied by the respondent. No remuneration is made.

10. The information collection conforms with the Privacy Act of 1974 and is subject to the conditions of disclosure contained therein. The records are maintained in the system identified as 36VA00, “Veterans and Armed Forces Personnel United States Government Life Insurance Records - VA” as contained in the Privacy Act Issuances, 1993 Compilation.

11. There are no questions of a sensitive nature.

12. We estimate that approximately 8,100 forms a year will be received and it will take approximately one hour and 45 minutes to complete this form. The annual burden will be 14,175 hours. The cost to reporting public is $212,625.00 (14,175 hours X $15/hour).

13. This submission does not involve any record keeping costs.

14. Cost to Government:

$7,282.00 Estimated mailing cost (8,100 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 8,100 X 38.2 cents each

(presort discount)).

$7,549.00 Estimated cost for collections (8,100 X 4 minutes

per X $13.98/hour (average salary of station collections

personnel)).

$53,541.00 Estimated cost for processing (8,100 forms X 20

minutes per form X $19.83/hour (average salary

for reviewers)).

$600.00 Estimated printing costs (10,000 X $60/1,000 forms).

$68,972.00 Total cost to the Government.

15. There is no change in respondent burden.

16. The information is collected for insurance purposes only and there are no plans for publication.

17. The collection instrument, VA Form 29-357, may be reproduced and/or stocked by the respondents and veteran service organizations. This VA form does not display an expiration date, and if required to do so would result in unnecessary waste of existing stock of this form. This form is submitted to OMB for approval every three years. As such, this date requirement would also result in an unnecessary burden on the respondents and would delay Department action on the benefit being sought. VA also seeks to minimize its cost to itself of collecting, processing and using the information by not displaying the expiration date. For the reasons stated, VA continues to seek an exemption that waives the displaying of the expiration date on this VA form.

18. There are no exceptions to the certification statement identified in Item 19 of

OMB Form 83-I.

Statistical Methods

The Veterans Benefits Administration does not collect information employing statistical methods.