Notice of Lapse & Application for Reinstatement

ICR 201203-2900-009

OMB: 2900-0128

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Supporting Statement A
2012-06-21
IC Document Collections
IC ID
Document
Title
Status
28339 Unchanged
ICR Details
2900-0128 201203-2900-009
Historical Active 200811-2900-016
VA 2900-0128
Notice of Lapse & Application for Reinstatement
Extension without change of a currently approved collection   No
Regular
Approved without change 08/31/2012
Retrieve Notice of Action (NOA) 07/05/2012
  Inventory as of this Action Requested Previously Approved
08/31/2015 36 Months From Approved 09/30/2012
23,352 0 23,352
4,459 0 4,459
0 0 0

These forms are used by an insured to reinstate a lapsed policy.

None
None

Not associated with rulemaking

  77 FR 71 04/12/2012
77 FR 124 06/07/2012
No

1
IC Title Form No. Form Name
Notice of Lapse & Application for Reinstatement 29-389, 29-389-1 Notice of Lapse & Application for Reinstatement ,   Notice of Past Due Payment & Application for Reinstatement

  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 23,352 23,352 0 0 0 0
Annual Time Burden (Hours) 4,459 4,459 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$109,773
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.
07/05/2012


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