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Federal forms, ICRs, and supporting documents

Information Collection Request

SERVICEMEMBERS’ GROUP LIFE INSURANCE – SPOUSE COVERAGE (FSGLI) ELECTION AND CERTIFICATE FORM (SGLV 8286A)

ICR 202309-2900-004 · OMB 2900-0938 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form SGLV 8286A SERVICEMEMBERS' GROUP LIFE INSURANCE – SPOUSE COVERAGE (FSGLI) ELECTION AND CERTIFICATE FORM (SGLV 8286A) Form New Repair queued
Supporting Statement(2900-NEW).docx Supporting Statement A Uploaded 2023-12-07 Repair queued
2023-26872.pdf Supplementary Document Uploaded 2023-12-07 Repair queued
2023-21800.pdf Supplementary Document Uploaded 2023-10-03 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
262351 SERVICEMEMBERS' GROUP LIFE INSURANCE – SPOUSE COVERAGE (FSGLI) ELECTION AND CERTIFICATE FORM (SGLV 8286A) Form New
ICR Details
202309-2900-004
Received in OIRA
VA VBA-INS-NK
SERVICEMEMBERS’ GROUP LIFE INSURANCE – SPOUSE COVERAGE (FSGLI) ELECTION AND CERTIFICATE FORM (SGLV 8286A)
New collection (Request for a new OMB Control Number)   No
Regular 12/07/2023
  Requested Previously Approved
36 Months From Approved
1,600 0
267 0
6,816 0
Family Servicemembers' Group Life Insurance (FSGLI) provides insurance coverage to spouses of Servicemember’s Group Life Insurance (SGLI) insured individuals. SGLI and all associated insurance programs are VA benefits. The SGLV 8286A form is used by Service Members and their spouses when the Service Member is unable to access their Servicemembers Group Life Insurance Online Enrollment System (SOES) account to electronically elect, increase, decrease or decline coverage. If the member is increasing or electing coverage on their spouse after prior declination or reduction and the spouse has health issues, the member’s uniformed service reviews the request and sends to the primary insurer for the SGLI program, The Prudential Insurance Company of America (Prudential), through its’ Office of Servicemembers’ Group Life Insurance (OSGLI), to underwrite and make a decision on coverage. This form ensures members, and their spouses can continue to use the form to manage their FSGLI spousal benefits.
None
None
Not associated with rulemaking
  88 FR 21800 10/03/2023
88 FR 26872 12/07/2023
No
  Total Request 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 1,600 0 0 1,600 0 0
Annual Time Burden (Hours) 267 0 0 267 0 0
Annual Cost Burden (Dollars) 6,816 0 0 6,816 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.
$16,694
No
    Yes
    Yes
No
No
No
No
Maribel Aponte 202 266-4688 [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.
12/07/2023