Claim for Disability Insurance Benefits, Government Life Insurance

ICR 201108-2900-014

OMB: 2900-0016

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2012-05-03
Supporting Statement A
2011-11-14
IC Document Collections
ICR Details
2900-0016 201108-2900-014
Historical Active 200806-2900-003
VA 2900-0016
Claim for Disability Insurance Benefits, Government Life Insurance
Extension without change of a currently approved collection   No
Regular
Approved with change 06/12/2012
Retrieve Notice of Action (NOA) 12/09/2011
Approved consistent with revised form submitted to OMB by VA and included in the public docket on 5/3/2012.
  Inventory as of this Action Requested Previously Approved
06/30/2015 36 Months From Approved 06/30/2012
8,100 0 8,100
14,175 0 14,175
0 0 0

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

Not associated with rulemaking

  76 FR 177 08/13/2011
76 FR 223 11/18/2011
No

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

  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 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

$68,972
No
No
No
No
No
Uncollected
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov

  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.
12/09/2011


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