Application for Ordinary Life Insurance (Age 65 and 70) (VA Forms 29-8485 & a; 29-8700, a, b, c, d & e; and 29-8701, a, b, c, d & e)

Forms and Documents

Document Name	Status
Form 29-8485 Application for Ordinary Life Insurance (Age 65 and 70) (29-8485 & a; 29-8700, a, b, c, d & e; and 29-8701, a, b, c, d & e) Form	Modified
Supporting Statement for 2900-0166.doc Supporting Statement A	2018-03-14
30-Day FRN -02900-0166 (2018).pdf Supplementary Document	2018-03-13
60-Day FRN - 2900-0166 (2017).pdf Supplementary Document	2018-03-13

IC Document Collections

IC ID	Document Title	Status
28407	Application for Ordinary Life Insurance (Age 65 and 70) (29-8485 & a; 29-8700, a, b, c, d & e; and 29-8701, a, b, c, d & e) Form	Modified

ICR Details

OMB Control No: 2900-0166	ICR Reference No: 201711-2900-002
Status: Active	Previous ICR Reference No: 201312-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-INS-YA
Title: Application for Ordinary Life Insurance (Age 65 and 70) (VA Forms 29-8485 & a; 29-8700, a, b, c, d & e; and 29-8701, a, b, c, d & e)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/17/2018
	Date Received in OIRA: 03/19/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved
Responses	15,400	0	0
Time Burden (Hours)	1,284	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: These forms are used by the insured to apply for replacement insurance for Modified Life at Age 65 and 70.

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Authorizing Statute(s): US Code: 38 USC 1904 Name of Law: Plans of Insurance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 230	12/01/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 6091	02/12/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Ordinary Life Insurance (Age 65 and 70) (29-8485 & a; 29-8700, a, b, c, d & e; and 29-8701, a, b, c, d & e)	29-8700, 29-8485a, 29-8700b, 29-8700c, 29-8700d, 29-8700e, 29-8701, 29-8701b, 29-8701c, 29-8701d, 29-8701e, 29-8485, 29-8700a, 29-8701a	Application for Ordinary Life Insurance ,   Application For Ordinary Life Insurance ,   Application For Ordinary Life Insurance (Age 65) ,   Application Letter 1 For Ordinary Life Insurance (Age 65) ,   Application Letter 2 for Ordinary Life Insurance (Age 65) ,   Application Letter 3 for Ordinary Life Insurance (Age 65) ,   Application Letter 4 for Ordinary Life Insurance (Age 65) ,   Application Letter 5 for Ordinary Life Insurance (Age 65) ,   Application for Ordinary Life Insurance (Age 70) ,   Application Letter 1 for Ordinary Life Insurance (Age 70) ,   Application Letter 2 for Ordinary Life Insurance (Age 70) ,   Application Letter 3 for Ordinary Life Insurance (Age 70) ,   Application Letter 4 for Ordinary Life Insurance (Age 70) ,   Application Letter 5 for Ordinary Life Insurance (Age 70)

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ICR Summary of Burden

	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	15,400	0	0	0	0	15,400
Annual Time Burden (Hours)	1,284	0	0	0	0	1,284
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $53,677

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/19/2018

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