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OMB Control No: 2900-0060	ICR Reference No: 202604-2900-002
Status: Received in OIRA	Previous ICR Reference No: 202408-2900-009
Agency/Subagency: VA	Agency Tracking No: VBA-INS-KM
Title: VA 29-4125, Clm for One Sum Paymt Gov Life Ins, VA 29-4125EZ, EZ-Ben Clm for One Sum Pymnt Gov Life Ins, VA 29-4125a Claim for Mthly Pymts Gov Life Ins, VA 29-4125e ((DocuSign) Claim for One Sum Paym
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/18/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2027
Responses	120,100	120,100
Time Burden (Hours)	12,010	12,010
Cost Burden (Dollars)	0	0

Annual Cost to Federal Government: $892,196

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: Kendra McCleave 202 461-9760 kendra.mccleave@va.gov

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