OMB2900-xxxx(sglv 8715)(6-12-14)

SUPPORTING STATEMENT

SGLV 8715

SGLI DISABILITY EXTENSION APPLICATION

2900-NEW

A. JUSTIFICATION

1. SGLI covered members who are totally disabled when released or separated from such service are entitled to a free extension of their SGLI coverage for the period of their total disability or two years, whichever ends first. This form is needed prior to expiration of the regulatory time periods so that totally disabled Veterans can apply for this free insurance benefit as soon as possible and receive an extension of their SGLI coverage in order to protect their beneficiaries in the event of their death. The information requested is authorized by law, 38 U.S.C. 1966(a), 1967(a), 38 U.S.C. 1968 (a) (1) – (4).

2. The information collected on the form is used by the Office of Servicemembers’ Group Life Insurance (OSGLI) to establish the insured's eligibility for the extension.

3. SGLV 8715 will be 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. SGLV 8715 is designed for use by OSGLI to determine the insured's eligibility for the extension.

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 April 7, 2014, Volume 79, Number 66, Page 19175. 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: 5,000 (We estimate that approximately 5000 forms a year will be received by OSGLI.)

b. Frequency of Response: Once

c. Annual Burden Hours: 2,083 Burden Hours

d. Estimated Completion Time: 25 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 $49,992. (2,083 burden hours X $24 per hour).

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

14. Cost to Government:

There will be no significant cost to VA since the form is returned to OSGLI for processing.

15. This is a new program.

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. There are no exceptions to the certification statement identified in Item 19 of OMB Form 83-I.

B. Collection of Information Employing Statistical Methods

This collection of information does not employ statistical methods.