Veterans Application for Assistance in Acquiring Special Housing Adaptations

Forms and Documents

Document Name	Status
Form 26-4555d Veterans Application for Assistance in Acquiring Special Housing Adaptations Form	Modified
OMB26-4555d(6-27-07)[1].doc Supporting Statement A	2007-07-11

IC Document Collections

IC ID	Document Title	Status
28521	Veterans Application for Assistance in Acquiring Special Housing Adaptations Form	Modified

ICR Details

OMB Control No: 2900-0300	ICR Reference No: 200706-2900-032
Status: Historical Active	Previous ICR Reference No: 200406-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0300
Title: Veterans Application for Assistance in Acquiring Special Housing Adaptations
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/20/2007
	Date Received in OIRA: 07/11/2007
Terms of Clearance: Approved consistent with the following terms of clearance: in the next submission of this collection to OMB for review VA shall report on the status of Dept. efforts to provide a fully electronic process for the completion and submission of forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	75	0	75
Time Burden (Hours)	25	0	25
Cost Burden (Dollars)	0	0	0

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Abstract: This form is completed on behalf of veterans who are blind, or veterans who have lost or lost the use of both hands, in applying for benefits as authorized by 38 U.S.C 2101(b) for acquiring adaptations to veterans' homes.

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Authorizing Statute(s): US Code: 38 USC 2101 Name of Law: Veterans eligible for assistance
  

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:
	72 FR 62	04/02/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 118	06/20/2007
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
Veterans Application for Assistance in Acquiring Special Housing Adaptations	26-4555d	Veterans Application for Assistance in Acquiring Special Housing Adaptations

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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	75	75	0	0	0	0
Annual Time Burden (Hours)	25	25	0	0	0	0
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: $1,446

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 07/11/2007

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