Information Collection

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

IC 28196 under ICR 202110-2900-003 · OMB 2900-0060.

⚠️ Notice: This information collection may be referencing outdated material.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

2024-11-15 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
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
Form 29-4125 Claim for One Sum Payment (Government Life 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	Form
Form 29-4125a Claim for Monthly Payments National Life 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	Form
Form 29-4125e Claim for One Sum Payment (Government Life Insurance) - Electronic Form 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
29-4125 Claim for One Sum Payment (Government Life Insurance) VA Form 29-4125 (508 Conformant 3-27-19).pdf	Form
29-4125 Claim for One Sum Payment (Government Life Insurance) VA Form 29-4125 (508 Conformant 3-27-19).pdf	Form
29-4125a Claim for Monthly Payments National Life Insurance VA Form 29-4125a (508 Conformant 3-21-19).pdf	Form
29-4125a Claim for Monthly Payments National Life Insurance VA Form 29-4125a (508 Conformant 3-21-19).pdf	Form
29-4125e Claim for One Sum Payment (Government Life Insurance) - VA Form 29-4125e (New Electronic Form) 10-19-21.pdf	Form
29-4125e Claim for One Sum Payment (Government Life Insurance) - VA Form 29-4125e (New Electronic Form) 10-19-21.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	29-4125	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	29-4125a	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	29-4125e		Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	120,100	120,100
Annual IC Time Burden (Hours)	12,010	12,010
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.

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