APPLICATION FOR VETERANS AFFAIRS LIFE INSURANCE (VALI) (VA Form 29-10277)

Forms and Documents

Document Name	Status
Form 29-10277 Application for Veterans Affairs Life Insurance (VALI) Form	New
30-Day FRN - 2900-NEW (VA Form 29-10277).pdf Supplementary Document	2022-04-27
Supporting Statement - 2900-NEW (VA Form 29-10277).docx Supporting Statement A	2022-04-22
Published 60-Day FRN.pdf Supplementary Document	2022-02-23

IC Document Collections

IC ID	Document Title	Status
251444	Application for Veterans Affairs Life Insurance (VALI) Form	New

ICR Details

OMB Control No:	ICR Reference No: 202112-2900-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-INS-YA
Title: APPLICATION FOR VETERANS AFFAIRS LIFE INSURANCE (VALI) (VA Form 29-10277)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/27/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	25,000	0
Time Burden (Hours)	8,333	0
Cost Burden (Dollars)	0	0

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Abstract: These forms are used by veterans to apply for Veterans Affairs Life Insurance (VALI), to designate a beneficiary and to select an optional settlement. The information is required by law, 38 USC, Section 1922.

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Authorizing Statute(s): US Code: 38 USC 1922 Name of Law: Service Disabled Veterans Insurance;
  

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:
	87 FR 8637	02/15/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 25087	04/27/2022
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 Veterans Affairs Life Insurance (VALI)	29-10277	Application for Veterans Affairs Life Insurance (VALI)

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ICR Summary of Burden

	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	25,000	0	0	25,000	0	0
Annual Time Burden (Hours)	8,333	0	0	8,333	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $442,554

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: 04/27/2022

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