VA MATIC Enrollment/Change (VA Form 29-0165)

ICR 201902-2900-006

OMB: 2900-0525

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2019-05-14
Supporting Statement A
2019-04-29
Supplementary Document
2019-02-28
IC Document Collections
IC ID
Document
Title
Status
28715 Modified
ICR Details
2900-0525 201902-2900-006
Active 201507-2900-002
VA VBA-INS-NK
VA MATIC Enrollment/Change (VA Form 29-0165)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 12/10/2019
Retrieve Notice of Action (NOA) 06/04/2019
VA will modify "Your obligation to respond is voluntary" to "Your response is voluntary" in the Privacy Act statement through a non-substantive change request within 45 days of approval of this reinstatement.
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved
5,000 0 0
1,250 0 0
0 0 0

VA Form 29-0165 is used by the insured to change the account number and/or bank from which a deduction was previously authorized. The information requested is authorized by law, 38 U.S.C. 1908.

US Code: 38 USC 1908 Name of Law: Premium payments
  
None

Not associated with rulemaking

  84 FR 2722 02/20/2019
84 FR 8959 05/02/2019
No

1
IC Title Form No. Form Name
VA MATIC Enrollment/Change VA Form 29-0165 VA MATIC Enrollment/Change

  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 5,000 0 0 0 0 5,000
Annual Time Burden (Hours) 1,250 0 0 0 0 1,250
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$15,088
No
    Yes
    Yes
No
No
No
Uncollected
Danny Green 202 421-1354 danny.green2@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.
06/04/2019


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