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Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities
Forms and Regulations for Grants to States for Construction and Acquisition of State Home Facilities
OMB: 2900-0661
IC ID: 28939
OMB.report
VA
OMB 2900-0661
ICR 200802-2900-002
IC 28939
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0661 can be found here:
2023-11-01 - Reinstatement without change of a previously approved collection
2014-10-03 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 10-0388-11
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities
Form and Instruction
10-0388 Forms Support List.pdf
www.va.gov/vaforms
Instruction
10-0388-2 CERTIFICATION OF COMPLIANCE WITH PROVISIONS OF THE DAVIS
10-0388-2-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-3 SPACE PROGRAM ANALYSIS - NURSING HOME & DOMICILIARY
10-0388-3-fillable.pdf
www.va.gov/vaforms
Form
10-0388-4 ADULT DAY HEALTH CARE
10-0388-4-fillable.pdf
www.va.gov/vaforms
Form
10-0388-5 ADDITIONAL DOCUMENTS AND INFORMATION REQUIRED FOR STATE
10-0388-5-fillable.pdf
www.va.gov/vaforms
Form
10-0388-6 CERTIFICATION OF STATE MATCHING FUNDS TO QUALIFY FOR GRO
10-0388-6-fillable.pdf
www.va.gov/vaforms
Form
10-0388-7 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
10-0388-7-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-8 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
10-0388-8-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-9 CERTIFICATION REGARDING LOBBYING
10-0388-9-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-10 CERTIFICATION OF COMPLIANCE WITH FEDERAL REQUIREMENTS
10-0388-10-fillable.pdf
www.va.gov/vaforms
Form
10-0388-11 MEMORANDUM OF AGREEMENT FOR A GRANT TO CONSTRUCT OR ACQU
10-0388-11-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-12 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBI
10-0388-12-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-13 DOCUMENTS AND CERTIFICATION REQUIRED FOR STATE HOME CONS
10-0388-13-fillable.pdf
www.va.gov/vaforms
Form and Instruction
10-0388-14 CHECKLIST OF MAJOR REQUIREMENTS FOR STATE HOME CONSTRUCT
10-0388-14-fillable.pdf
www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities
Agency IC Tracking Number:
2900-0661
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
10-0388-11
MEMORANDUM OF AGREEMENT FOR A GRANT TO CONSTRUCT OR ACQUIRE A STATE VETERANS HOME
10-0388-11-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form and Instruction
10-0388-12
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS
10-0388-12-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form and Instruction
10-0388-13
DOCUMENTS AND CERTIFICATION REQUIRED FOR STATE HOME CONSTRUCTION AND ACQUISITION GRANTS - POST-GRANT REQUIREMENTS
10-0388-13-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-14
CHECKLIST OF MAJOR REQUIREMENTS FOR STATE HOME CONSTRUCTION/ACQUISITION GRANTS
10-0388-14-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Instruction
10-0388 Forms Support List.pdf
www.va.gov/vaforms
No
Printable Only
Form and Instruction
10-0388-2
CERTIFICATION OF COMPLIANCE WITH PROVISIONS OF THE DAVIS-BACON ACT
10-0388-2-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-3
SPACE PROGRAM ANALYSIS - NURSING HOME & DOMICILIARY
10-0388-3-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-4
ADULT DAY HEALTH CARE
10-0388-4-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-5
ADDITIONAL DOCUMENTS AND INFORMATION REQUIRED FOR STATE HOME CONSTRUCTION AND ACQUISITION GRANTS APPLICATION
10-0388-5-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-6
CERTIFICATION OF STATE MATCHING FUNDS TO QUALIFY FOR GROUP 1 ON THE PRIORITY LIST
10-0388-6-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form and Instruction
10-0388-7
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
10-0388-7-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form and Instruction
10-0388-8
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS FOR GRANTEES OTHER THAN INDIVIDUALS
10-0388-8-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form and Instruction
10-0388-9
CERTIFICATION REGARDING LOBBYING
10-0388-9-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-0388-10
CERTIFICATION OF COMPLIANCE WITH FEDERAL REQUIREMENTS
10-0388-10-fillable.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
60
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
60
0
0
0
0
60
Annual IC Time Burden (Hours)
360
0
0
0
0
360
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.