Information Collection

Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)

IC 28874 under ICR 202407-2900-004 · OMB 2900-0618.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SGLV 8284A Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	Form
Form SGLV 8284A Claim for Accelerated Benefits Servicemembers’ Group Life Insurance Family Coverage (FSGLI) Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	Form
Form SGLV 8284 Claim for Accelerated Benefits Servicemembers’ Group Life Insurance (SGLI) Veterans’ Group Life Insurance (VGLI) Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	Form
SGLV 8284A Claim for Accelerated Benefits Servicemembers’ Group Lif SGLV 8284A 09-30-24.pdf www.benefits.va.gov/insurance/	Form
SGLV 8284A Claim for Accelerated Benefits Servicemembers’ Group Lif SGLV 8284A 09-30-24.pdf www.benefits.va.gov/insurance/	Form
SGLV 8284 Claim for Accelerated Benefits Servicemembers’ Group Lif SGLV 8284 09-30-24.pdf www.benefits.va.gov/insurance/	Form
SGLV 8284 Claim for Accelerated Benefits Servicemembers’ Group Lif SGLV 8284 09-30-24.pdf www.benefits.va.gov/insurance/	Form

IC Title:

Agency IC Tracking Number:

2900-0618

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 9.14(e)

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	SGLV 8284A			https://www.benefits.va.gov/insurance/	Yes	Yes	Fillable Printable
Form	SGLV 8284			https://www.benefits.va.gov/insurance/	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: 36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance - VA

FR Citation: 89 FR 63254

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	40	40
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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