Supporting Statement for VA Form 29-1549 (4-22-14)

SUPPORTING STATEMENT

VA FORM 29-1549

APPLICATION FOR CHANGE OF PERMANENT PLAN - MEDICAL

2900-0179

JUSTIFICATION:

1. The form is used by the Department of Veterans Affairs (VA) to determine the insured’s eligibility to change his/her plan of insurance from a higher reserve to a lower reserve. The information on the form is required by law, 38 CFR Sections 6.48 and 8.36. This form was changed to a revision after the 30-day FRN was published due to adding the expiration date placeholder to the form.

2. The data collected on the form is used to establish eligibility of the applicant for the purpose of the change.

3. VA Form 29-1549 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 insured to establish his/her eligibility to change insurance plans.

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, page 46417. No comments were 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.

1. Number of Respondents: 28

2. Frequency of Response: Once

3. Annual Burden Hours: 14 hours

4. Estimated Completion Time: 30 minutes

5. 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 $336.00.

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

14. Cost to Government:

$25.00 Estimated mailing cost (28 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 28 X 38.2 cents each

(presort discount)).

$13.00 Estimated cost for collections (28 X 2 minutes

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

personnel)).

$139.00 Estimated cost for processing (28 forms X 15

minutes per form X $19.83/hour (average salary

for reviewers)).

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

$207.00 Total cost to the Government.

$210.00 Cost to reporting public (14 hours X $15/hour)

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

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.

PART B

B. Collection of Information Employing Statistical Methods

This collection of information does not employ statistical methods.