Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0014 can be found here:

Documents and Forms

Document Name Document Type
Form 28-1905 Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status Form
28-1905 Authorization and Certification of Entrance or Reentranc 28-1905.pdf www.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status	Agency IC Tracking Number:	2900-0014

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.332 38 CFR 21.320 48 CFR 871.201-2 38 CFR 21.294 38 CFR 21.321 38 CFR 21.322

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	28-1905	Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status	28-1905.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	90,000	8,000	82,000
Annual IC Time Burden (Hours)	7,500	667	6,833
Annual IC Cost Burden (Dollars)	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.