Application for Supplemental Service Disabled Veterans Insurance (VA Forms 29-0188 and 29-0189)

Forms and Documents

Document Name	Status
Form VA Form 29-0188 Application for Supplemental Service Disabled Veterans Insurance Form	Modified
2020-14821.pdf Supplementary Document	2020-07-13
Supporting Statement (3-9-20).pdf Supporting Statement A	2020-05-13
2020-06498.pdf Supplementary Document	2020-05-05

IC Document Collections

IC ID	Document Title	Status
28718	Application for Supplemental Service Disabled Veterans Insurance Form	Modified

ICR Details

OMB Control No: 2900-0539	ICR Reference No: 202003-2900-007
Status: Active	Previous ICR Reference No: 201604-2900-004
Agency/Subagency: VA	Agency Tracking No: VBA-INS-NK
Title: Application for Supplemental Service Disabled Veterans Insurance (VA Forms 29-0188 and 29-0189)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/20/2020
	Date Received in OIRA: 09/15/2020
Terms of Clearance: In VA's next revision, extension, or reinstatement request, VA shall assess whether responses are voluntary or required to obtain or retain a benefit and state this requirement in plain language.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved
Responses	10,000	0	0
Time Burden (Hours)	3,333	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The VA Forms 29-0188 and 29-0189 are used to apply for Supplemental Service Disabled Insurance.

---

Authorizing Statute(s): PL: Pub.L. 102 - 568 203 Name of Law: Supplemental Service Disabled Veterans' Insurance For Totally Disabled Veterans
   US Code: 38 USC 1922 Name of Law: Service disabled veterans' insurance
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 17620	03/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 14821	07/10/2020
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Application for Supplemental Service Disabled Veterans Insurance	VA Form 29-0188, VA Form 29-0189	Application for Supplemental Service-Disabled Veterans Insurance (SRH) ,   Application for Supplemental Service-Disabled Veterans (SRH) Life Insurance

---

ICR Summary 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	10,000	0	0	0	0	10,000
Annual Time Burden (Hours)	3,333	0	0	0	0	3,333
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:

---

Annual Cost to Federal Government: $174,454

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

---

Common Form ICR:  No

---

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: 09/15/2020

---