Application for Change of Permanent Plan (Medical) (VA Form 29-1549)

ICR 201707-2900-006

OMB: 2900-0179

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2018-03-06
Supplementary Document
2018-01-30
Supporting Statement A
2018-03-06
IC Document Collections
IC ID
Document
Title
Status
28423 Modified
ICR Details
2900-0179 201707-2900-006
Active 201307-2900-004
VA VBA-INS-YA
Application for Change of Permanent Plan (Medical) (VA Form 29-1549)
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 05/17/2018
Retrieve Notice of Action (NOA) 03/19/2018
  Inventory as of this Action Requested Previously Approved
05/31/2021 36 Months From Approved
28 0 0
14 0 0
0 0 0

This form is designed for use by the insured to establish eligibility to change insurance plans. The information is authorized by law, 38 CFR Section 6.48 and 8.36.

US Code: 38 USC 1944 Name of Law: Policy provisions
   US Code: 38 USC 1906 Name of Law: Policy provisions
  
None

Not associated with rulemaking

  82 FR 57029 12/01/2017
83 FR 5165 02/05/2018
No

1
IC Title Form No. Form Name
Application for Change of Permanent Plan (Medical) 29-1549 Application for Change of Permanent Plan (Medical)

  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 28 0 0 0 0 28
Annual Time Burden (Hours) 14 0 0 0 0 14
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$207
No
    Yes
    Yes
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@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.
03/19/2018


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