OMBfl29-30a(3-6-14)

SUPPORTING STATEMENT FOR

VA FORM LETTER 29-30A,

SUPPLEMENTAL DISABILITY REPORT

2900-0129

A. JUSTIFICATION

1. The form letter is used by the insured to supply information in conjunction with claim for disability benefits. The information requested is authorized by law, 38 USC Sections 1912, 1915, 1942 and 1948.

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 data collected on the form letter is used by the Department of Veterans Affairs (VA) when evaluating the claim for disability insurance benefits.

3. VA Form 29-30A 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 letter is designed for use by VA to determine the insured’s eligibility to obtain 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 November 29, 2013, Volume 78, No. 230, page 71725. 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. Provide estimates of the hour burden of the collection.

We arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form.

a. Number of Respondents: 6,570

b. Frequency of Response: On Occasion

c. Annual Burden Hours: 548 hours

d. Estimated Completion Time: 5 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 $13,152. (548 burden hours X $24 per hour).

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

14. Cost to Government:

$5,907.00 Estimated mailing cost (6,570 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 6,570 X 38.2 cents each

(presort discount)).

$3,062.00 Estimated cost for collections (6,570 X 2 minutes

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

personnel)).

$21,714.00 Estimated cost for processing (6,570 forms X 10

minutes per form X $19.83/hour (average salary

for reviewers)).

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

$30,713.00 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. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS:

This collection of information does not employ statistical methods.