BO SURVEY

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

SUPPORTING STATEMENT – PART A
VA FORM 29-4125 Claim for One Sum Payment Government Life Insurance
VA FORM 29-4125e (DocuSign)Claim for One Sum Payment Government Life Insurance
VA FORM 29-4125a Claim for Monthly Payments National Service Life Insurance
VA FORM 29-4125EZ Beneficiary Claim for One Sum Payment Government Life Insurance
2900-0060

Summary of Changes:

    • This ICR is being submitted as an “Revision” due to the creation of a new form.
    • This information collection request (ICR) package includes the VA Form 
29-4125EZ that was previously added to the collection. 
    • The addition of the new form will not affect the burden for this collection. 
    • Title:  Claim for One Sum Payment Government Life Insurance, VA Form 29-4125.
Claim for One Sum Payment Government Life Insurance, VA Form 29-4125e(DocuSign).
Claim for Monthly Payments National Service Life Insurance, VA Form 29-4125a.
EZ-Beneficiary Claim for One Sum Payment Government Life Insurance, VA Form 29-4125EZ
    • No comments were received during the 60-day comment period.




    1. Need for the Information Collection

These forms are used by beneficiaries applying for proceeds of Government Life Insurance policies.  The VA Form 29-4125EZ has been added to this collection.  This is an easier, simple version of the 29-4125.  This form was created so individual beneficiaries can have a less complicated form to complete without all the additional content for other types of beneficiaries.  This will not affect the number of respondents but will make it easier and reduce the time it takes for beneficiaries to receive their insurance proceeds.  The information requested on the forms is required by law, 38 USC Sections 1917 and 1952.

    2. Use of the Information

The information collected on these forms are used by the Department of Veterans Affairs (VA) to process the beneficiaries claim for payment of the insurance proceeds.

    3. Use of the Information Technology

The VA Forms 29-4125, 29-4125EZ and 29-4125a are available on the One-VA web site in a fillable electronic format.  VBA is currently hosting these forms on a secure server and does not currently have the technology in place to allow for the complete submission of these forms.  Validation edits are performed to assure data integrity.  Efforts within VA are underway to provide a mechanism to allow the information to be submitted electronically with a recognized signature technology.  There currently is no utility process in place that will allow the data submitted on these forms to be incorporated with an existing centralized legacy database.  The 29-4125e is an electronic version of the 29-4125 and supports digital signature through VA approved DocuSign.

    4. Non-duplication 

The information is not contained in any other VA records.  Similar information is not available elsewhere.

    5. Burden on Small Businesses

The information does not involve any small businesses.

    6. Less Frequent Collection

These forms are designed for use by the claimant to establish his/her eligibility to collect the proceeds of the insurance.  It is only collected once, at the time when the claim is received. 

    7. Paperwork Reduction Act Guidelines

There are no special circumstances requiring that the collection of information be conducted in a manner inconsistent with the guidelines in 5 CFR Section 1320.6.

    8. Consultation and Public Comments

Part A: PUBLIC NOTICE:

A 60-Day Federal Register Notice for the collection published on Monday, June 1, 2026.  The 60-Day FRN citation is 91 FRN 32513. 

No comments were received during the 60-day comment period.

A 30-Day Federal Register Notice for the collection published on Wednesday, August 12, 2026.  The 30-Day FRN citation is 91 FRN 52111.

Part B: CONSULTATION:

No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.

    9. Gifts or Payment

No payments or gifts are being offered to respondents as an incentive to participate in the collection.

    10. Confidentiality

The information collection conforms to the Privacy Act of 1974 and is subject to the conditions of disclosure contained therein. The records are maintained in the system identified as 36VA29 Veterans and Uniformed Services Personnel Program of U.S. Government Life Insurance – VA” as contained in the Privacy Act Issuances, 2011 Compilation.

    11. Sensitive Questions

There are no questions of a sensitive nature.

    12. Respondent Burden and its Labor Costs

        a. Number of Respondents: 120,100(VA Forms 29-4125, 29-4125EZ and 29-4125e) and 100 (VA Form 29-4125a).  The VA Form 29-4125EZ is new and is the short simple version of the 29-4125.  This will not create more, or less respondents.  It’s just an easier way the same respondents can apply for the insurance proceeds.
        b. Frequency of Response: One time
        c. Annual Burden Hours – 12,010 (VA Form 29-4125, 29-4125EZ and 29-4125e) and 10 hours (29-4125a).
        d. Estimated Completion Time: 6 minutes
        e. VA cannot make assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA uses general wage data to estimate the respondents’ costs associated with completing the information collection.
The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers. According to the latest available BLS data, the mean hourly wage is $32.66 based on the BLS wage code – “00-0000 All Occupations.” This information was taken from the following website: https://data.bls.gov/oes/#/industry/000000, May 2024.  
Legally, respondents may not pay a person or business for assistance in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $392,573 (12,020 burden hours x $32.66 per hour).  
    13. Respondent Costs Other Than Burden Hour Costs

This submission does not involve any record keeping costs.

    14. Costs to the Federal Government

Grade
Step
Burden Time
Fraction of Hour
Hourly Rate
Cost Per Response
Total Responses
Total
9
3
6
0.1
$26.95
$2.70
   120,100
$324,270.00
Overhead at 100% Salary
$324,270.00
5
3
2
0.03
$17.79 
$0.53
   120,100
$63,653.00
Overhead at 100% Salary
$63,653.00
4
3
2
0.03
$15.90
$0.48
   120,100
$57,648.00
Overhead at 100% Salary
$57,648.00
 

Processing / Analyzing Costs
$891,142.00
Printing and Production Cost
$54.00
Total Cost to Government                   
$892,196.00

Overhead costs are 100% of salary and are the same as the wage listed above and the amounts are included in the total.  

Printing and production costs approximates the cost of printing this information collection per year.  (Processing/Analyzing Cost total divided by $54).

Note: The hourly wage information above is based on the hourly 2025 General Schedule (Base) Pay (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/26Tables/html/GS_h.aspx).  This rate does not include any locality adjustment as applicable.

The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form.  The within-grade step (3) of each employee represents the average experience of employees within each grade.
		 

    15. Reason for Change in Burden

There is no change in respondent burden.

    16. Publication of Results

The information is collected for insurance purposes only and there are no plans for publication.

    17. Non-Display of OMB Expiration Date

We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.

    18. Exceptions to “Certification for Paperwork Reduction Submissions”

We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.