Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance

Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance- VA Forms 29-4125 & 4125A

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0060 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 29-4125 Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance Form
VA Form 29-4125 Claim for One Sum Payment (Government Life Insurance) 29-4125(2-22-16).pdf www.va.gov/vaforms Form
VA Form 29-4125a Claim for Monthly Payments National Life Insurance 29-4125a(2-22-16).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Claim for One Sum Payment (Government Life Insurance), Claim for Monthly Payments (National Service Life Insurance), and Claim for Monthly Payments, U.S. Government Insurance	Agency IC Tracking Number:	2900-0060

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 29-4125	Claim for One Sum Payment (Government Life Insurance)	29-4125(2-22-16).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 29-4125a	Claim for Monthly Payments National Life Insurance	29-4125a(2-22-16).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	120,100	35,750	84,350
Annual IC Time Burden (Hours)	12,010	3,500	8,510
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.