SGLI Disability Extension Application and Instructions (SGLV 8715)

Forms and Documents

Document Name	Status
Form SGLV 8715 SGLI Disability Extension Application and Instructions (SGLV 8715) Form and Instruction	New
30-Day FRN (2900-NEW)(SGLV-8715).pdf Supplementary Document	2014-06-30
60-day FRN(2900-NEW)(SGLV-8715).pdf Supplementary Document	2014-06-17
OMB2900-XXXX(SGLV 8715)(6-12-14).doc Supporting Statement A	2014-06-17

IC Document Collections

IC ID	Document Title	Status
211931	SGLI Disability Extension Application and Instructions (SGLV 8715) Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201406-2900-019
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-NEW VBA-INS-DB
Title: SGLI Disability Extension Application and Instructions (SGLV 8715)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/24/2014
	Date Received in OIRA: 07/08/2014
Terms of Clearance: VA has requested to withdraw this information collection request from OMB review.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The SGLI Disability Extension Application provides coverage for up to 2 years from the date of separation at no cost to the veteran.

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Authorizing Statute(s): US Code: 38 USC 1966(a) Name of Law: Eligible Insurance companies
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 66	04/07/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 125	06/30/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SGLI Disability Extension Application and Instructions (SGLV 8715)	SGLV 8715	SGLI Disability Extension Application and Instructions

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new program. We estimate that approximately 5,000 forms a year will be received by OSGLI. We estimate that it will take approximately 25 minutes to complete this form. We arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/08/2014

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