OMB2900-0469(29-541)(9-26-14)

SUPPORTING STATEMENT

VA FORM 29-541

CERTIFICATE SHOWING RESIDENCE AND HEIRS OF DECEASED

VETERANS OR BENEFICIARY

2900-0469

JUSTIFICATION:

1. The form is used by the Department of Veterans Affairs (VA) to establish entitlement to Government Life Insurance proceeds in estate cases when formal administration of the estate is not required. The information on the form is required by law, Title 38, USC Sections 1917 and 1950.

2. The information collected on the form is used by the Department of Veterans Affairs (VA) to determine entitlement to Government Life Insurance proceeds.

3. This form is available on our website “insurance.va.gov.” in a pdf format. Due to low usage, this form cannot be submitted electronically at this time.

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 form is used by VA to solicit information regarding entitlement to proceeds.

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 January 16, 2014, Volume 79, Number 11, Page 2944. There are no persons outside the Department of Veterans Affairs with whom the material submitted was discussed. There was one public comment.

The comment was submitted by the Executive Director of the Family Equality Council. The comment requested that we change the “Mother” and “Father” fields to read “Parent 1” and “Parent 2”. Our response was: “A task force has been assigned to look into new language to be used within VBA”.

The decision has been made to change “Mother” and “Father” to Parent(s).

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. Estimate of Information Collection Burden

a. Number of Respondents: 2,078

b. Frequency of Response: On occasion

c. Annual Burden Hours: 1,039 burden hours (We arrived at this estimate by initiating a trial with a VA staff member unfamiliar with the form.)

d. Estimated Completion Time: 30 Minutes

e. According to the U.S. Bureau of Labor Statistics Average Hourly Earnings, the cost to the respondent is $24, making the total cost to the respondents an estimated $24,936. (1,039 burden hours X $24 per hour).

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

14. Cost to Government:

$1,869.00 Estimated mailing cost (2,078 X 2 minutes per

form X $15.51/hour (average salary for station

mail personnel) plus 2,078 X 38.2 cents each

(presort discount)).

$968.00 Estimated cost for collections (2,078 X 2 minutes

per X $13.98/hour (average salary of station collections

personnel)).

$10,302.00 Estimated cost for processing (2,078 forms X 15

minutes per form X $19.83/hour (average salary

for reviewers)).

$90.00 Estimated printing costs (3,000 X $30/1,000 forms).

$13,229.00 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. We are not seeking approval to omit the expiration date for OMB approval.

18. This submission does not contain any exceptions to the certification statement.

B. Collection of Information Employing Statistical Methods.

The Veterans Benefits Administration does not collect information employing statistical methods.