Vaf29-4125(8-13)

SUPPORTING STATEMENT

VA Form 29-4125, Claim for Life Insurance Proceeds (NSLI & USGLI)

VA Form 29-4125a, Claim for Monthly Installments (NSLI)

VA Form 29-4125k, Claim for Monthly Installments (USGLI)

2900-0060

JUSTIFICATION:

1. These forms are used by beneficiaries applying for proceeds of Government Insurance policies. The information requested on the forms are required by law, 38 USC Sections 1917 and 1952. A social security number field has been added as this number is required when requesting direct deposit.

2. The information collected on these forms are used by the Department of Veterans Affairs (VA) to process the beneficiaries claim for payment of the insurance proceeds.

3. These VA Forms are available on the One-VA web site 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 these forms. Validation edits are performed to assure data integrity. Efforts within VA are underway to provide a mechanism to allow the information to be submitted electronically with a recognized signature technology. There currently is no utility process in place that will allow the data submitted on the form to be incorporated with an existing centralized legacy database.

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. These forms are designed for use by the claimant to establish his/her eligibility to collect the proceeds of the insurance. It is only collected once, at the time when the claim is received.

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 March 26, 2013, Page 18425. There are no persons outside the Department of Veterans Affairs with whom the material submitted was discussed. There were no public contacts. The information does not involve obtaining information from any state or local Government. There is no person or organization other than VA that will collect the information which is submitted by the insured. No comments were received.

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 82,000 VA Form 29-4125’s a year will be received. We estimate that it will take approximately 6 minutes to complete this form. We estimate that approximately 1,850 VA Form 29-4125a’s a year will be received. We estimate that it will take approximately 6 minutes to complete this form. We estimate that approximately 500 VA Form 29-4125k’s a year will be received. We estimate that it will take approximately 15 minutes to complete this form. We arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form. The annual burden will now be 8,200 hours, 185 hours, and 125 hours respectively.

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

14. Cost to Government for VA Forms 29-4125 and 29-4125a:

$73,718.00 Estimated mailing cost (82,000 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 82,000 X 38.2 cents each

(presort discount)).

$38,212.00 Estimated cost for collections (82,000 X 2 minutes

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

personnel)).

$325,212.00 Estimated cost for processing (82,000 forms X 12

minutes per form X $19.83/hour (average salary

for reviewers)).

$2,460.00 Estimated printing costs (82,000 X $30/1,000 forms).

$439,602.00 Total cost to the Government.

$123,000.00 Cost to reporting public (8,200 hours X $15/hour).

Cost to Government for VA Form 29-4125a:

$1,663.00 Estimated mailing cost (1,850 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 1,850 X 38.2 cents each

(presort discount)).

$862.00 Estimated cost for collections (1850 X 2 minutes

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

personnel)).

$7,337.00 Estimated cost for processing (1,850 forms X 12

minutes per form X $19.83/hour (average salary

for reviewers)).

$56.00 Estimated printing costs (1,850 X $30/1,000 forms).

$9,918.00 Total cost to the Government.

$2,775.00 Cost to reporting public (185 hours X $15/hour).

Cost to Government for VA Form 29-4125k:

$450.00 Estimated mailing cost (500 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 500 X 38.2 cents each

(presort discount)).

$233.00 Estimated cost for collections (500 X 2 minutes

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

personnel)).

$1,983.00 Estimated cost for processing (500 forms X 12

minutes per form X $19.83/hour (average salary

for reviewers)).

$30.00 Estimated printing costs (1,000 X $30/1,000 forms).

$2,696.00 Total cost to the Government.

$750.00 Cost to reporting public (50 hours X $15/hour).

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 instruments, VA Forms 29-4125, 29-4125a, and 29-4125k, may be reproduced and/or stocked by the respondents and veteran service organizations. These VA forms do not display an expiration date, and if required to do so would result in unnecessary waste of existing stocks of these forms. These forms are 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 these VA forms.

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

OMB Form 83-I.

Statistical Methods

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