SUPPLEMENTAL TO INSURANCE MEDICAL APPLICATION

ICR 198102-2900-004

OMB: 2900-0072

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
146871 Migrated
ICR Details
2900-0072 198102-2900-004
Historical Active 197701-2900-066
VA
SUPPLEMENTAL TO INSURANCE MEDICAL APPLICATION
Revision of a currently approved collection   No
Regular
Approved without change 03/17/1981
Retrieve Notice of Action (NOA) 02/18/1981
  Inventory as of this Action Requested Previously Approved
03/31/1984 03/31/1984 04/30/1981
5,000 0 5,000
416 0 416
0 0 0

THE FORM IS USED BY AN APPLICANT TO ADVISE THE VA THAT A MEDICAL EXAMINATION IS BEING PERFORMED FOR USE ON A MEDICAL APPLICATION REQUIRED TO CHANGE A PLAN OF INSURANCE, REINSTATE, ADD TDIP OR REPLACE AN EXPIRED TERM POLICY. WHEN RECEIVED, THE FORM IS DIARIED FOR ACTION TO BE TAKEN ON THE MEDICAL APPLICATION.

None
None


No

1
IC Title Form No. Form Name
SUPPLEMENTAL TO INSURANCE MEDICAL APPLICATION 29-352A

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 416 416 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
02/18/1981


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