2900-0324 justification

SUPPORTING STATEMENT

VA FORM 29-8146, 29-8158, 29-8160

SUPPLEMENTAL PHYSICAL EXAMINATION REPORT

ATTENDING PHYSICIAN’S STATEMENT,

SUPPLEMENTAL PHYSICAL EXAMINATION REPORT (DIABETES – PHYSICIAN’S REPORT)

2900-0324

JUSTIFICATION:

1. The forms are used by the Department of Veterans Affairs (VA) to obtain complete information as to the physical and/or mental condition of a veteran who has submitted an application for insurance or reinstatement. The information requested is required by law, Title 38 USC Section 1922, and 38 CFR Section 8.25.

2. The data collected on these forms are used by insurance personnel to process the insured’s request.

3. These forms 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 the 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 the forms to be incorporated with an existing centralized legacy database.

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

5. The information does not involve any small businesses.

6. The forms are designed for use by a veteran’s physician.

7. 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. The Department notice was published in the Federal Register on April 21, 2008 (Volume 73, Number 77), page 21413. No comments were received in response to this notice.

9. The information collected is supplied by the respondent. No remuneration is made.

10. The information collection conforms with the Privacy Act of 1974 and is subject to the conditions of disclosure contained therein. The records are maintained in the system identified as 36VA00, “Veterans and Armed Forces Personnel United States Government Life Insurance Records - VA” as contained in the Privacy Act Issuances, 1993 Compilation.

11. There are no questions of a sensitive nature.

12. Estimates of Information Collection Burden:

VA Forms	Number of Respondents	Minutes/60	Burden Hours
29-8158	1,000	45	750
29-8146	220	45	165
29-8160	220	45	165

The cost to the reporting public is $16,200.00 (1,080 hours X $15/hour).

13. This submission does not involve any record keeping costs.

14. Cost to Government for VA Form 29-8158:

$527.00 Estimated mailing cost (1,000 X 2 minutes per

form X $7.45/hour (average salary for station

mail personnel) plus 1,000 X 27.9 cents each

(presort discount)).

$264.00 Estimated cost for collections (1,000 X 2 minutes

per X $7.91/hour (average salary of station collections

personnel)).

$3,038.00 Estimated cost for processing (1,000 forms X 15

minutes per form X $12.15/hour (average salary

for reviewers)).

$30.00 Estimated printing costs (1,000 X $30/1,000 forms).

$3,859.00 Total cost to the Government.

Cost to Government for VA Form 29-8146:

$116.00 Estimated mailing cost (220 X 2 minutes per

form X $7.45/hour (average salary for station

mail personnel) plus 220 X 27.9 cents each

(presort discount)).

$58.00 Estimated cost for collections (220 X 2 minutes

per X $7.91/hour (average salary of station collections

personnel)).

$668.00 Estimated cost for processing (220 forms X 15

minutes per form X $12.15/hour (average salary

for reviewers)).

$15.00 Estimated printing costs (500 X $30/1,000 forms).

$857.00 Total cost to the Government.

Cost to Government for VA Form 29-8160:

$116.00 Estimated mailing cost (220 X 2 minutes per

form X $7.45/hour (average salary for station

mail personnel) plus 220 X 27.9 cents each

(presort discount)).

$58.00 Estimated cost for collections (220 X 2 minutes

per X $7.91/hour (average salary of station collections

personnel)).

$668.00 Estimated cost for processing (220 forms X 15

minutes per form X $12.15/hour (average salary

for reviewers)).

$15.00 Estimated printing costs (500 X $30/1,000 forms).

$857.00 Total cost to the Government.

15. There is no change in respondent burden.

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

17. The collection instruments, VA Form 29-8146, 29-8158, 29-8160, may be reproduced and/or stocked by the respondents and veteran service organizations. These VA forms do not display an expiration date, and if required to do so would result in unnecessary waste of existing stock of these forms. These forms are submitted to OMB for approval every three years. As such, this date requirement would also result in an unnecessary burden on the respondents and would delay Department action on the benefit being sought. VA also seeks to minimize its cost to itself of collecting, processing and using the information by not displaying the expiration date. For the reasons stated, VA continues to seek an exemption that waives the displaying of the expiration date on these VA Forms.

18. There are no exceptions to the certification statement identified in Item 19 of

OMB Form 83-I.

Statistical Methods

This data collection does not employ statistical methods.