Application for Conversion (Government Life Insurance) (VA Form 29-0152)

ICR 202104-2900-008

OMB: 2900-0149

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-06-28
Supplementary Document
2021-05-04
Supporting Statement A
2021-04-12
IC Document Collections
IC ID
Document
Title
Status
28374 Modified
ICR Details
2900-0149 202104-2900-008
Received in OIRA 201707-2900-005
VA VBA-INS-MS
Application for Conversion (Government Life Insurance) (VA Form 29-0152)
Reinstatement with change of a previously approved collection   No
Regular 06/28/2021
  Requested Previously Approved
36 Months From Approved
4,500 0
1,125 0
0 0

The application form is used by the insured to convert to a permanent plan of insurance.

US Code: 38 USC 1904 Name of Law: plans of insurance
   US Code: 38 USC 1942 Name of Law: plans of insurance
  
None

Not associated with rulemaking

  86 FR 20793 04/21/2021
86 FR 34122 06/28/2021
No

1
IC Title Form No. Form Name
Application for Conversion (Government Life Insurance) 29-0152 APPLICATION FOR CONVERSION GOVERNMENT LIFE INSURANCE

  Total Request 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 4,500 0 0 0 0 4,500
Annual Time Burden (Hours) 1,125 0 0 0 0 1,125
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$63,189
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 maribel.aponte@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.
06/28/2021


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