Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)

ICR 201802-2900-003 · OMB 2900-0618 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0618 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form SGLV8284 Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	Form	Unchanged	Available
2900-0618 Supporting Statement (09.21.18).docx	Supporting Statement A	Uploaded 2018-09-21	Available
30-day FRN - 2900-0618 (2018).pdf	Supplementary Document	Uploaded 2018-06-20	Available
60-day FRN - 2900-0618 (2018).pdf	Supplementary Document	Uploaded 2018-05-03	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
28874	Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	Form	Unchanged

ICR Details

OMB Control No: 2900-0618	ICR Reference No: 201802-2900-003
Status: Active	Previous ICR Reference No: 201403-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-INS-YA
Title: Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/24/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/22/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved
Responses	200	0	0
Time Burden (Hours)	40	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The SGLV 8284 form is used by an insured who is terminally ill to request payment of a portion of the face value of the SGLI or VGLI as an Accelerated Benefit.

Authorizing Statute(s): US Code: 38 USC 1980 Name of Law: Option to Receive Accelerated Death Benefit
PL: Pub.L. 105 - 368 302 Name of Law: Veterans Programs Enhancement Act of 1998

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12653	03/22/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 24163	05/24/2018
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application by Insured Terminally Ill Person for Accelerated Benefit (SGLV 8284)	SGLV8284	Servicemember's and Veterans' Group Life Insurance Accelerated Benefits Option

ICR Summary of Burden

	Total Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses	200	200
Annual Time Burden (Hours)	40	40
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Cynthia Harvey - Pryor 202 461-5870 [email protected]

Common Form ICR: No