Application for Reinstatement (Lapsed More than 6 Months), Application for Reinstatement (Non Medical - Comparative Health Statement) (VA Forms 29-352 and 29-353)

Forms and Documents

Document Name	Status
Form VA Form 29-352 Application for Reinstatement and or Total Disability Income Provision Form	Modified
2020-18323.pdf Supplementary Document	2020-08-21
2900-0011 Supporting Statement.docx Supporting Statement A	2020-06-18
2020-13091.pdf Supplementary Document	2020-06-18

IC Document Collections

IC ID	Document Title	Status
28089	Application for Reinstatement and or Total Disability Income Provision Form	Modified

ICR Details

OMB Control No: 2900-0011	ICR Reference No: 202005-2900-010
Status: Active	Previous ICR Reference No: 201604-2900-002
Agency/Subagency: VA	Agency Tracking No: VBA-INS-NK
Title: Application for Reinstatement (Lapsed More than 6 Months), Application for Reinstatement (Non Medical - Comparative Health Statement) (VA Forms 29-352 and 29-353)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/20/2020
	Date Received in OIRA: 09/22/2020
Terms of Clearance: VA shall review to determine if responses are voluntary or required to obtain or retain a benefit and state in plain language on these forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved
Responses	3,000	0	0
Time Burden (Hours)	1,125	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The VA Forms 29-352 and 29-353 forms are used to apply for reinstatement of life insurance.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 13091	06/18/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 18323	08/21/2020
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Reinstatement and or Total Disability Income Provision	VA Form 29-352, VA Form 29-353	Application for Reinstatement (Insurance lapesed more than 6 months) Government Life Insurance and/or Total Disability Income Provision ,   Application for Reinstatement (Non Medical - Comparative Health Statement) Government Life Insurance

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ICR Summary of Burden

	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	3,000	0	0	0	0	3,000
Annual Time Burden (Hours)	1,125	0	0	0	0	1,125
Annual Cost Burden (Dollars)	0	0	0	0	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:

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Annual Cost to Federal Government: $59,394

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

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/22/2020

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