Claim for Disability Insurance Benefits, Government Life Insurance (VA Form 29-357)

ICR 202203-2900-014

OMB: 2900-0016

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2022-06-22
Supporting Statement A
2022-06-09
Supplementary Document
2022-03-24
IC Document Collections
ICR Details
2900-0016 202203-2900-014
Received in OIRA 201805-2900-005
VA VBA-INS-YA
Claim for Disability Insurance Benefits, Government Life Insurance (VA Form 29-357)
Extension without change of a currently approved collection   No
Regular 06/22/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
8,100 8,100
14,175 14,175
0 0

VA Form 29-357 is designed for use by the insurance activity to determine the insured's eligibility for disability insurance benefits. The information is authorized by law, USC Sections 1912, 1915, 1942, 1948.

US Code: 38 USC 1942 Name of Law: Plans of Insurance
   US Code: 38 USC 1948 Name of Law: Total Disability Provision
   US Code: 38 USC 1912 Name of Law: Total Disability Waiver
   US Code: 38 USC 1915 Name of Law: Total Disability Income Provision
  
None

Not associated with rulemaking

  87 FR 16827 03/24/2022
87 FR 37375 06/22/2022
No

1
IC Title Form No. Form Name
Claim for Disability Insurance Benefits, Government Life Insurance 29-357 Claim for Disability Insurance Benefits, Government Life Insurance

  Total Request 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 8,100 8,100 0 0 0 0
Annual Time Burden (Hours) 14,175 14,175 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$45,900
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/22/2022


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