SUPPORTING STATEMENT
VA FORM LETTER 29-551
REPORT OF TREATMENT IN HOSPITAL
2900-0119
JUSTIFICATION:
1. The form letter is used for collecting information from hospitals 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.
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. Due to privacy concerns, this form will not be made available as an electronic submission. In the future, this form will be considered as a fillable for but not as an electronic transaction due to the nature of medical records.
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 June 12, 2014, Volume 79, Number 113, Page 33807. 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.
Number of Respondents: 20,277
Frequency of Response: as needed
Annual Burden Hours: 4,055
Estimated Completion Time: 12 minutes
According to the U.S. Bureau of Labor Statistics Avergae Hourly Earnings, the cost to the respondent is $24, making the total cost to the respondents an estimated $97,320.00
(4,055 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.
15. There have not been any program changes or adjustments. The expiration date placeholder has been 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.
1. This collectionof information does not employ statistical methods.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT |
| Author | Veterans Benefits Administrat |
| Last Modified By | Kessinger, Nancy, VBAVACO |
| File Modified | 2014-08-06 |
| File Created | 2014-08-06 |