SUPPORTING STATEMENT
VA Form 29-4125, Claim for Life Insurance Proceeds (NSLI & USGLI)
VA Form 29-4125a, Claim for Monthly Installments (NSLI)
2900-0060
JUSTIFICATION:
1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.
These forms are used by beneficiaries applying for proceeds of Government Insurance policies. The information requested on the forms is required by law, 38 USC Sections 1917 and 1952. The VA Forms 29-4125 and 29-4125A are being revised to add a block requesting the beneficiary’s email address. USGI policies previously used the VA Form 29-4125K to request proceeds, however these are now covered by VA Form 29-4125a, therefore we are discontinuing the form.
2. Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.
The information collected on these forms is used by the Department of Veterans Affairs (VA) to process the beneficiaries claim for payment of the insurance proceeds.
3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.
These VA Forms are 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 these forms. 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. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.
The information is not contained in any other VA records. Similar information is not available elsewhere.
5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.
The information does not involve any small businesses.
6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.
These forms are designed for use by the claimant to establish his/her eligibility to collect the proceeds of the insurance. It is only collected once, at the time when the claim is received.
7. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.
There are no special circumstances requiring that the collection of information be conducted in a manner inconsistent with the guidelines in 5 CFR Section 1320.6.
8. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.
The Department notice was published in the Federal Register on March 24, 2016, Volume 81, No. 57, page 15789. No comments were received.
9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.
No payments or gifts to respondents have been made under this collection of information.
10. Describe any assurance of privacy, to the extent permitted by law, provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
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. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.
There are no questions of a sensitive nature.
12. Estimate of the hour burden of the collection of information:
Number of Respondents - 120,100 (VA Form 29-4125) and
100 (VA Form 29-4125a).
Frequency of Response – One time
Annual Burden Hours – 12,010 (VA Form 29-4125) and 10 hours (29-4125a).
Estimated Completion Time - 6 minutes
The respondent population is composed of beneficiaries of the proceeds of Government Life Insurance policies. VBA cannot make further assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA used general wage data to estimate the respondents’ costs associated with completing the information collection.
The Bureau of Labor Statistics gathers information on full-time wage and salary workers. Accordingly, the median weekly earnings of full-time wage and salary workers is $809.00. Assuming a forty (40) hour work week, the median hourly wage is $20.23.
Legally, respondents may not pay a person or business for assistance in completing the information collection and a person or business may not accept payment for assisting a respondent in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $242,962.30
(12,010 burden hours x $20.23).
13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).
This submission does not involve any record keeping costs.
14. Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.
Cost to Government for VA Forms 29-4125:
$107,880.00 Estimated mailing cost (120,000 X 2 minutes per
form X $15.51/hour (average salary for station
mail personnel) plus 120,000 X 38.2 cents each
(presort discount)).
$55,920.00 Estimated cost for collections (120,000 X 2 minutes
per X $13.98/hour (average salary of station collections
personnel)).
$475,920.00 Estimated cost for processing (120,000 forms X 12
minutes per form X $19.83/hour (average salary
for reviewers)).
$639,720.00 Total cost to the Government.
Cost to Government for VA Form 29-4125a:
$89.90 Estimated mailing cost (100 X 2 minutes per
form X $15.51/hour (average salary for station
mail personnel) plus 100 X 38.2 cents each
(presort discount)).
$46.60 Estimated cost for collections (100 X 2 minutes
per X $13.98/hour (average salary of station collections
personnel)).
$396.60 Estimated cost for processing (100 forms X 12
minutes per form X $19.83/hour (average salary
for reviewers)).
$533.10 Total cost to the Government.
15. Explain the reason for any burden hour changes since the last submission.
The increase in burden is due to the receipt of more forms requesting the proceeds form Government Life Insurance policies, as more veterans pass away.
The forms are being revised to request the beneficiary’s email address.
16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.
The information is collected for insurance purposes only and there are no plans for publication.
17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
We are not seeking approval to omit the expiration date for OMB approval.
18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.
There are no exceptions to the certification statement identified in Item 19 of
OMB Form 83-I.
B. Collection of Information Employing Statistical Methods
1. The Veterans Benefits Administration does not collect information employing statistical methods.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT |
| Author | Kessinger, Nancy, VBAVACO |
| Last Modified By | Department of Veterans Affairs |
| File Modified | 2016-12-06 |
| File Created | 2016-12-06 |