OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Claim for Disability Insurance Benefits, Government Life Insurance (29-357)

ICR 201406-2900-030 · OMB 2900-0016 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 29-357 Claim for Disability Insurance Benefits, Government Life Insurance Form Modified Available
30-Day FRN (2900-0016)(5-8-15).pdf Supplementary Document Uploaded 2015-06-02 Available
60-Day FRN (2900-0016)(12-19-14).pdf Supplementary Document Uploaded 2015-02-18 Available
2900-0016(29-357)(4-27-15).doc Supporting Statement A Uploaded 2015-04-28 Available
IC Document Collections
IC IDCollectionTypeStatusForm
28103 Claim for Disability Insurance Benefits, Government Life Insurance Form Modified
ICR Details
2900-0016 201406-2900-030
Historical Active 201108-2900-014
VA 2900-0016 VBA-INS-DB
Claim for Disability Insurance Benefits, Government Life Insurance (29-357)
Revision of a currently approved collection   No
Regular
Approved without change 07/17/2015
Retrieve Notice of Action (NOA) 06/08/2015
  Inventory as of this Action Requested Previously Approved
07/31/2018 36 Months From Approved 07/31/2015
8,100 0 8,100
14,175 0 14,175
0 0 0
This form is designed for use by the insurance activity to determine the insured's eligibility for disability insurance benefits. The information is authorized by law, USC Sections 1912, 1915, 1942, 1948.
US Code: 38 USC 1942 Name of Law: Plans of Insurance
   US Code: 38 USC 1948 Name of Law: Total Disability Provision
   US Code: 38 USC 1912 Name of Law: Total Disability Waiver
   US Code: 38 USC 1915 Name of Law: Total Disability Income Provision
  
None
Not associated with rulemaking
  79 FR 244 12/19/2014
80 FR 89 05/08/2015
No
1
IC Title Form No. Form Name
Claim for Disability Insurance Benefits, Government Life Insurance 29-357 Claim for Disability Insurance Benefits
  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 8,100 8,100 0 0 0 0
Annual Time Burden (Hours) 14,175 14,175 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$68,972
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [email protected]
  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.
06/08/2015