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

ICR 202104-2900-008 · OMB 2900-0149 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0149 can be found here:

2024-06-20 - Extension without change of a currently approved collection

Forms and Documents

Document	Type	Status	Availability
Form 29-0152 Application for Conversion (Government Life Insurance)	Form	Modified	Repair queued
Published 30-Day FRN.pdf	Supplementary Document	Uploaded 2021-06-28	Repair queued
2900-0149 Final 60-day.pdf	Supplementary Document	Uploaded 2021-05-04	Repair queued
Supporting Statement (4-2-21).docx	Supporting Statement A	Uploaded 2021-04-12	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
28374	Application for Conversion (Government Life Insurance)	Form	Modified

ICR Details

OMB Control No: 2900-0149	ICR Reference No: 202104-2900-008
Status: Received in OIRA	Previous ICR Reference No: 201707-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-INS-MS
Title: Application for Conversion (Government Life Insurance) (VA Form 29-0152)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/28/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	4,500	0
Time Burden (Hours)	1,125	0
Cost Burden (Dollars)	0	0

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

Authorizing Statute(s): US Code: 38 USC 1904 Name of Law: plans of insurance
US Code: 38 USC 1942 Name of Law: plans of insurance

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:
	86 FR 20793	04/21/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 34122	06/28/2021
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 for Conversion (Government Life Insurance)	29-0152	APPLICATION FOR CONVERSION GOVERNMENT LIFE INSURANCE

ICR Summary of Burden

	Total Request	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,500	4,500
Annual Time Burden (Hours)	1,125	1,125
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: $63,189

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? No

Agency Contact: Maribel Aponte 202 266-4688 [email protected]

Common Form ICR: No