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VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr
VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs
OMB: 2900-0793
IC ID: 204870
OMB.report
VA
OMB 2900-0793
ICR 201211-2900-008
IC 204870
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0793 can be found here:
2023-02-17 - Revision of a currently approved collection
2020-08-06 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form VA form 10-0491
VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr
Form
VA form 10-0491 HPSP/VIOMPSP Academic Verification
10-0491_Academic Verification.PDF
To be determined
Form
VA Form 10-0491a HPSP/VIOMPSP Addendum to Application
10-0491a_Addendum to Application.pdf
Form
VA Form 10-0491c HPSP/VIOMPSP Annual VA employment deferment Verification
10-0491c_Annual VA Employment_Deferment Verification.pdf
Form
VA Form 10-0491d HPSP/VIOMPSP Education Program Completion Notice_Service
10-0491d_Education Program Completion Notice_Service Obligation Placement.pdf
Form
VA Form 10-0491e HPSP/VIOMPSP Evaluation Recommendation Form
10-0491e_Evaluation_Recommendation Form.pdf
Form
VA Form 10-0491f HPSP Agreement
10-0491f_HPSP Agreement.revised.pdf
Form
VA Form 10-0491g HPSP/VIOMPSP Application
10-0491g_HPSP_VIOMPSP Application.pdf
Form and Instruction
VA Form 10-0491h HPSP/VIOMPSP Notice of Approaching Graduation
10-0491h_Notice of Approaching Graduation.pdf
Form
VA Form 10-0491i HPSP/VIOMPSP Notice of Change and/or Annual Academic Sta
10-0491i_Notice of Change_Annual Academic Status Report.pdf
Form
VA Form 10-0491j HPSP/VIOMPSP Request for Deferment for Advanced Educatio
10-0491j_Request for Deferment for Advanced Education.pdf
Form
VA Form 10-0491k HPSP/VIOMPSP VA Scholarship Offer Response
10-0491k_VA Scholarship Offer Response.pdf
Form
VA Form 10-0491L VIOMPSP Agreement
10-0491L_VIOMPSP Agreement.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR Part 17 (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA form 10-0491
HPSP/VIOMPSP Academic Verification
10-0491_Academic Verification.PDF
To be determined
Yes
No
Fillable Printable
Form
VA Form 10-0491a
HPSP/VIOMPSP Addendum to Application
10-0491a_Addendum to Application.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491c
HPSP/VIOMPSP Annual VA employment deferment Verification
10-0491c_Annual VA Employment_Deferment Verification.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491d
HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement
10-0491d_Education Program Completion Notice_Service Obligation Placement.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491e
HPSP/VIOMPSP Evaluation Recommendation Form
10-0491e_Evaluation_Recommendation Form.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491f
HPSP Agreement
10-0491f_HPSP Agreement.revised.pdf
TBD
Yes
No
Fillable Printable
Form and Instruction
VA Form 10-0491g
HPSP/VIOMPSP Application
10-0491g_HPSP_VIOMPSP Application.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491h
HPSP/VIOMPSP Notice of Approaching Graduation
10-0491h_Notice of Approaching Graduation.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491i
HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report
10-0491i_Notice of Change_Annual Academic Status Report.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491j
HPSP/VIOMPSP Request for Deferment for Advanced Education
10-0491j_Request for Deferment for Advanced Education.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491k
HPSP/VIOMPSP VA Scholarship Offer Response
10-0491k_VA Scholarship Offer Response.pdf
TBD
Yes
No
Fillable Printable
Form
VA Form 10-0491L
VIOMPSP Agreement
10-0491L_VIOMPSP Agreement.pdf
TBD
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
6,500
0
6,500
0
0
0
Annual IC Time Burden (Hours)
32,689
0
32,689
0
0
0
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.