OMB29-4499a(3-6-14)

SUPPORTING STATEMENT

VA FORM 29-4499A

NOTICE - PAYMENT NOT APPLIED

2900-0139

A. JUSTIFICATION:

1. This form is used by the policyholder to reinstate an NSLI policy. The information requested is authorized by law, 38 CFR Section 8.23.

The 30-day FRN indicated this was an extension, however the minor revision to the form makes it a revision. . The expiration date is being added to the form.

2. The information collected on the form is used by the Department of Veterans Affairs (VA) to establish the insured's eligibility for reinstatement.

3. VA Form 29-4499A 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 eligibility of the applicant for reinstatement of his/her insurance.

7. There are no special circumstances requiring that the collection 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 46423-46424. 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 in resonse 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 arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form.

a. Number of Respondents: 1,200

b. Frequency of Response: On Occasion

c. Annual Burden Hours: 300

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 $7,200. (300 burden hours X $24 per hour).

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

14. Cost to Government:

$1,079.00 Estimated mailing cost (1,200 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 1,200 forms X 38.2 cents

each (presort discount)).

$1,118.00 Estimated cost for collections (1,200 X 4 minutes

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

collections personnel)).

$1,983.00 Estimated cost for processing (1,200 forms X

5 minutes per form X $19.83/hour (Average

salary for reviewers)).

$60.00 Estimated printing costs (2,000 X $30/1,000

forms).

$4,240.00 Total cost to the Government.

15. There is no change in respondent burden. The expiration date is being 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.