OMB
.report
Search
Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)
Application by Insured Terminally Ill Person for Accelerated Benefit (Forms SGLV 8284 & SGLV 8284a)
OMB: 2900-0618
IC ID: 28874
OMB.report
VA
OMB 2900-0618
ICR 202407-2900-004
IC 28874
( )
Documents and Forms
Document Name
Document Type
Form SGLV 8284A
Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)
Form
SGLV 8284A Claim for Accelerated Benefits Servicemembers’ Group Lif
SGLV 8284A 09-30-24.pdf
www.benefits.va.gov/insurance/
Form
SGLV 8284A Claim for Accelerated Benefits Servicemembers’ Group Lif
SGLV 8284A 09-30-24.pdf
www.benefits.va.gov/insurance/
Form
SGLV 8284 Claim for Accelerated Benefits Servicemembers’ Group Lif
SGLV 8284 09-30-24.pdf
www.benefits.va.gov/insurance/
Form
SGLV 8284 Claim for Accelerated Benefits Servicemembers’ Group Lif
SGLV 8284 09-30-24.pdf
www.benefits.va.gov/insurance/
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)
Agency IC Tracking Number:
2900-0618
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 9.14(e)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SGLV 8284A
Claim for Accelerated Benefits Servicemembers’ Group Life Insurance Family Coverage (FSGLI)
SGLV 8284A 09-30-24.pdf
https://www.benefits.va.gov/insurance/
Yes
Yes
Fillable Printable
Form
SGLV 8284
Claim for Accelerated Benefits Servicemembers’ Group Life Insurance (SGLI) Veterans’ Group Life Insurance (VGLI)
SGLV 8284 09-30-24.pdf
https://www.benefits.va.gov/insurance/
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Legislative Functions
Privacy Act System of Records
Title:
36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance - VA
FR Citation:
89 FR 63254
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
40
0
0
0
0
40
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.