Information Collection

Claim for Disability Insurance Benefits, Government Life Insurance

IC 28103 under ICR 201805-2900-005 · OMB 2900-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 29-357 Claim for Disability Insurance Benefits, Government Life Insurance	Form
VA Form 29-357 Claim for Disability Insurance Benefits - Government Lif 29-357(8-14-18).pdf www.va.gov/vaforms	Form

IC Title:

Claim for Disability Insurance Benefits, Government Life Insurance

Agency IC Tracking Number:

2900-0016

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 29-357	Claim for Disability Insurance Benefits - Government Life Insurance	29-357(8-14-18).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Veterans & Armed Forces Personnel U.S. Government Life Insurance Records

FR Citation: 84 FR 2232

Number of Respondents: 8,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	8,100	8,100
Annual IC Time Burden (Hours)	14,175	14,175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.