OMBFL29-551a(3-17-14)

OMBFL29-551a(3-17-14).doc

Report of Treatment by Attending Physician (FL29-551A)

OMB: 2900-0120

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SUPPORTING STATEMENT FOR

VA FORM LETTER 29-551A,

REPORT OF TREATMENT BY ATTENDING PHYSICIAN

2900-0120



JUSTIFICATION:


1. The form letter is used for collecting information from attending physicians to determine the insured's eligibility for disability insurance benefits. The information requested is authorized by law, 38 U.S.C. 1912, 1915, 1942 and 1948. The expiration date is being added to the form letter.


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


3. VA Form 29-551A 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 the 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 the insurance activity to determine the insured's eligibility for continued protection. The collection is generally conducted only once.


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 January 15, 2014, Volume 79, Number 10, pages 2752-2753. 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 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. Estimate of Information Collection Burden


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


a. Number of Respondents: 20,277

b. Frequency of Response: On Occasion

c. Annual Burden Hours: 5,069 hours

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 $14,928. (622 burden hours x $24 per hour).


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


14. Cost to Government:


$18,229.00 Estimated mailing cost (20,277 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 20,277 form letters X 38.2 cents

each (presort discount)).


$18,898.00 Estimated cost for collections (20,277 X 4 minutes

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

collections personnel)).


$100,523.00 Estimated cost for processing (20,277 form letters 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).


$137,680.00 Total cost to the Government.


$76,035.00 Cost to reporting public (5,069 hours X $15/hour).


15. There have not been any program changes or adjustments. 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.

File Typeapplication/msword
AuthorVBA USER
Last Modified ByBolyard, Dottie, VBAVACO
File Modified2014-03-17
File Created2014-03-17

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