SUPPORTING STATEMENT – PART A
VA Form 29-4125 Claim for One Sum Payment Government Life Insurance
VA Form 29-4125e (DocuSign) Claim for One Sum Payment Government Life Insurance
VA Form 29-4125a Claim for Monthly Payments National Service Life Insurance
OMB Control Number 2900-0060
Summary of Changes:
Claim for One Sum Payment Government Life Insurance, VA Form 29-4125e(DocuSign). Claim for Monthly Payments National Service Life Insurance, VA Form 29-4125a.
29-4125e (DocuSign version).
change in burden.
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Need for the Information Collection
These forms are used by beneficiaries applying for proceeds of Government Insurance policies. The information requested on the forms are required by law, 38 USC Sections 1917 and 1952. A social security number field has been added as this number is required when requesting direct deposit.
The VA Forms 29-4125 and 29-4125e are being updated to reduce development and provide quicker claims processing based on the new law that was passed. The claim forms were divided into sections, making it easier for beneficiaries to fill out the information that is needed for their circumstance, and to ensure, payment in a timelier manner. The instructions were revised for each section providing additional guidance on which documents are needed to submit with the claim form, such as a death certificate, trust documents, letters of testamentary, wills, and a VA Form 29-541 Certificate Showing Residence and Heirs of Deceased Veteran or Beneficiary in certain instances. Direct deposit instructions and a sample check showing banking information were also added to these forms.
Use of the Information
The information collected on these forms are used by the Department of Veterans Affairs (VA) to process the beneficiaries claim for payment of the insurance proceeds.
Use of the Information Technology
The VA Forms 29-4125 and 29-4125a are available on the One-VA web site in a fillable electronic format. VBA is currently hosting these forms on a secure server and does not currently have the technology in place to allow for the complete submission of these forms. Validation edits are performed to assure data integrity. Efforts within VA are underway to provide a mechanism to allow the information to be submitted electronically with a recognized signature technology. There currently is no utility process in place that will allow the data submitted on these forms to be incorporated with an existing centralized legacy database. The 29-4125e is an electronic version of the 29-4125 and supports digital signature through VA approved DocuSign.
Non-duplication
The information is not contained in any other VA records. Similar information is not available elsewhere.
Burden on Small Businesses
The information does not involve any small businesses.
Less Frequent Collection
These forms are designed for use by the claimant to establish his/her eligibility to collect the proceeds of the insurance. It is only collected once, at the time when the claim is received.
Paperwork Reduction Act Guidelines
There are no special circumstances requiring that the collection of information be conducted in a manner inconsistent with the guidelines in 5 CFR Section 1320.6.
Consultation and Public Comments
Part A: PUBLIC NOTICE:
A 60-Day Federal Register Notice (FRN) for the collection published on Tuesday, September 10, 2024. The 60-Day FRN citation is Vol. 89 FRN 73508.
No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Friday, November 15, 2024. The 30-Day FRN citation is Vol. 89 FRN 90395.
Part B: CONSULTATION:
No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.
Gifts or Payment
No payments or gifts are being offered to respondents as an incentive to participate in the collection.
Confidentiality
The information collection conforms to the Privacy Act of 1974 and is subject to the conditions of disclosure contained therein. The records are maintained in the system identified as 36VA29 Veterans and Uniformed Services Personnel Program of U.S. Government Life Insurance – VA” as contained in the Privacy Act Issuances, 2011 Compilation.
Sensitive Questions
There are no questions of a sensitive nature.
Respondent Burden and its Labor Costs
Number of Respondents: 120,100(VA Form 29-4125 and 29-4125e) and 100 (VA Form 29-4125a). The VA Form 29-4125e is new and is the electronic version of the 29-4125. This will not create more, or less respondents. It’s just a different way the same respondents can apply for the insurance proceeds.
Frequency of Response: One time
Annual Burden Hours – 12,010 (VA Form 29-4125 and 29-4125e) and 10 hours (29-4125a).
Estimated Completion Time: 6 minutes
VA cannot make further assumptions about the population of respondents because of the variability of factors such as the educational background and wage potential of respondents. Therefore, VBA used general wage data to estimate the respondents’ costs associated with completing the information collection.
The Bureau of Labor Statistics (B:S) gathers information on full-time wage and salary workers. According to the latest available BLS data, the mean weakly earnings of full-time wage and salary workers are $1,259.20. Assuming a forty (40) hour work week, the mean hourly wage is $31.48 based on the BLS wage code – “00-0000 All Occupations.” This information was taken from the following website: (https://www.bls.gov/oes/current/oes_nat.htm, May 2023).
Legally, respondents may not pay a person or business for assistance in completing the information collection. Therefore, there are no expected overhead costs for completing the information collection. VBA estimates the total cost to all respondents to be $378,390 (12,020 burden hours x $31.48 per hour).
Respondent Costs Other Than Burden Hour Costs
This submission does not involve any record keeping costs.
Costs to the Federal Government
Grade |
Step |
Burden Time |
Fraction of Hour |
Hourly Rate |
Cost Per Response |
Total Responses |
Total |
9 |
3 |
6 |
0.1 |
$26.24 |
$2.62 |
120,100 |
$314,662.00 |
Overhead at 100% Salary |
$314,662.00 |
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5 |
3 |
2 |
0.03 |
$17.31 |
$0.52 |
120,100 |
$62,452.00 |
Overhead at 100% Salary |
$62,452.00 |
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4 |
3 |
2 |
0.03 |
$15.48 |
$0.46 |
120,100 |
$55,246.00 |
Overhead at 100% Salary |
$55,246.00 |
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|
||||||
Processing / Analyzing Costs |
$864,720.00 |
||||||
Printing and Production Cost |
$54.00 |
||||||
Total Cost to Government |
$864,774.00 |
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Overhead costs are 100% of salary and are the same as the wage listed above and the amounts are included in the total.
Printing and production costs approximates the cost of printing this information collection per year. (Processing/Analyzing Cost total divided by $54).
Note: The hourly wage information above is based on the hourly 2024 General Schedule (Base) Pay (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/24Tables/html/GS_h.aspx). This rate does not include any locality adjustment as applicable.
The processing time estimates above are based on the actual amount of time employees of each grade level spend to process to completion a claim received on this form. The within-grade step (3) of each employee represents the average experience of employees within each grade.
Reason for Change in Burden
There is no change in respondent burden.
Publication of Results
The information is collected for insurance purposes only and there are no plans for publication.
Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
Exceptions to “Certification for Paperwork Reduction Submissions”
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |