Supporting Statement - 2900-0149 - 20-0344 (3-25-14)

SUPPORTING STATEMENT

VA FORM 29-0152

APPLICATION FOR CONVERSION

2900-0149

JUSTIFICATION:

The form is used by the insured to convert to a permanent plan of insurance. The information on the form is required by law, USC 1904 and 1942. Form was initially submitted as an extension. However, it has been changed to a revision for adding the expiration date placeholder.

2. The information collected on the form is used by the Insurance Activity to initiate the processing of the insured’s request to convert his/her term insurance.

3. VA Form 29-0152 is 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 this form. 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. The form is designed for use by the Insurance Activity to determine the insured’s requested plan of insurance.

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 July 31, 2013, Volume 78, number 147, pages 46420 and 46421. 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 to 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 4,500 forms a year will be received. We also 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 1,125 hours. Cost to reporting public (1,125 hours X $15/hour is $16,875.00.

a. Number of Respondents: 4,500

b. Frequency of Response: Once

c. Annual Burden Hours: 1,125

d. Estimated Completion Time: 15 minutes

e. According to the U.S. Bureau of Labor Statistics Average Hourly Earnings, the cost to the respondent is $24, making the total cost to the respondents an estimated $27,000.

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

14. Cost to Government:

$4,046.00 Estimated mailing cost (4,500 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 4,500 X 38.2 cents each

(presort discount)).

$2,097.00 Estimated cost for collections (4,500 X 2 minutes

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

personnel)).

$66,926.00 Estimated cost for processing (4,500 forms X 45

minutes per form X $19.83/hour (average salary

for reviewers)).

$150.00 Estimated printing costs (10,000 X $15/1,000 forms).

$73,219.00 Total cost to the Government

15. There is no change in respondent burden. The expiration date placeholder was added to the form.

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

17. We are not seeking approval to omit the expiration date for OMB approval.

18. This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods

This collection of information does not employ statistical methods.