OMBfl29-615(3-20-14)

SUPPORTING STATEMENT

VA FORM LETTER 29-615

REQUEST FOR SUPPLEMENTAL INFORMATION ON MEDICAL

AND NONMEDICAL APPLICATIONS

2900-0131

A. JUSTIFICATION.

1. The form letter is used by the policyholder to apply for new issue, reinstate or change plan on NSLI policies. The information is authorized by law, 38 CFR 8.11. 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 reinstatement, change of plan, or a new issue of insurance. The form is also used by the insured or their representatives as a certification of health. The VA must verify that the insured has not been ill or suffered or contracted any disease, infirmity or other injury which prevents the insured from attending his/her usual occupation. The insured must report any illness, disease, injury or medical treatments along with dates.

3. VA Form Letter 29-615 Should not be available on the Internet. This item is partially completed and appropriate paragraphs are inserted on an internal MS Word system (PC Letters) and mailed to the policyholder for completion and return. As a complete form, it would be of no use to the policyholder without the information VA would provide initially.

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 reinstatement, change of plan, or a new issue of insurance. 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 December 30, 2013, Volume 78, Number 250, page 79564. 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

a. Number of Respondents: 9,000

b. Frequency of Response: On occasion

c. Annual Burden Hours: 3,000 Burden Hours

d. Estimated Completion Time: 20 Minutes (We arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form.)

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 $72,000. (3,000 burden hours X $24 per hour)..

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

14. Cost to Government:

$8,091.00 Estimated mailing cost (9,000 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 9,000 form letters X 38.2 cents

each (presort discount)).

$8,388.00 Estimated cost for collections (9,000 X 4 minutes

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

collections personnel)).

$14,873.00 Estimated cost for processing (9,000 form letters X

5 minutes per form X $19.83/hour (Average

salary for reviewers)).

$270.00 Estimated printing costs (9,000 X $30/1,000

forms).

$31,622.00 Total cost to the Government.

$45,000.00 Cost to reporting public (3,000 hours X $15/hour).

15. There have not been any program changes or adjustments. The expiration date is being added to the form letter.

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.

B. Collection of Information Employing Statistical Methods.

This collection of information does not employ statistical methods.