Application for Reinstatement (Lapsed More than 6 Months), Application for Reinstatement (Non Medical - Comparative Health Statement) (VA Forms 29-352 and 29-353)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 29-352 Application for Reinstatement and or Total Disability Income Provision	Form	Modified	Available
2900-0011 Supporting Statement.doc	Supporting Statement A	Uploaded 2016-11-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28089	Application for Reinstatement and or Total Disability Income Provision	Form	Modified

ICR Details

OMB Control No: 2900-0011	ICR Reference No: 201604-2900-002
Status: Historical Active	Previous ICR Reference No: 201303-2900-016
Agency/Subagency: VA	Agency Tracking No: VBA-INS-NK
Title: Application for Reinstatement (Lapsed More than 6 Months), Application for Reinstatement (Non Medical - Comparative Health Statement) (VA Forms 29-352 and 29-353)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/12/2017
	Date Received in OIRA: 11/22/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved	04/30/2017
Responses	3,000	0	3,000
Time Burden (Hours)	1,125	0	1,125
Cost Burden (Dollars)	0	0	0

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Abstract: The VA Forms 29-352 and 29-353 forms are used to apply for reinstatement of life insurance.

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Authorizing Statute(s): None

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:
	81 FR 21037	09/01/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24164	10/06/2016
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for Reinstatement and or Total Disability Income Provision	VA Form 29-353, VA Form 29-352	Application for Reinstatement (Insurance lapesed more than 6 months) Government Life Insurance and/or Total Disability Income Provision ,   Application for Reinstatement (Non-medical - Comparative Health Statement) Government Life Insurance

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,000	3,000	0	0	0	0
Annual Time Burden (Hours)	1,125	1,125	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $19,058

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: 11/22/2016

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