Supporting Statement for 2900-0031 - VAF 26-4555c (7-29-14)

VA FORM 26-4555c

VETERAN/SERVICEMEMBER’S SUPPLEMENTAL APPLICATION FOR

ASSISTANCE IN ACQUIRING SPECIALLY ADAPTED HOUSING

(2900-0031)

A. Justification

1. Title 38, U.S.C., chapter 21, authorizes a VA program of grants for specially adapted housing for disabled veterans or servicemembers. Section 2101(a) of this chapter specifically outlines those determinations that must be made by VA before such grant is approved for a particular veteran or servicemember. VA Form 26-4555c is used to collect information that is necessary for VA to meet the requirements of 38 U.S.C. 2101(a). (Also, see 38 CFR 36.4402(a), 36-4404(a), and 36.4405.) This form was changed from an extension to a revision to add the expiration date placeholder.

2. The form is used by Loan Guaranty personnel in approving the benefit available under 38 U.S.C. 2101(a). The information requested is necessary in order to determine if it is economically feasible for a veteran or servicemember to reside in specially adapted housing and to compute the proper grant amount.

3. This form is available in a fillable electronic format on the One VA forms website at http://www.va.gov/vaforms. Once a determination on eligibility is made and the file is reviewed by Loan Guaranty personnel, the veteran or servicemember is directed to complete VA Form 26-4555c with instructions. An electronic submission system would not allow for personal customer service, and would delay applications from being processed due to errors. VA will continue to explore the use of information technology to submit this form.

4. The information collected on VA Form 26-4555c is unique to VA and is not duplicated in other agencies' records or in other VA records.

5. The collection of information does not involve small businesses.

6. The information collected on this form is completed by veterans who are applying for assistance in acquiring specially adapted housing. The data furnished on this form is essential to determining grant approval under 38 U.S.C. 2101(a). The collection is generally conducted only once.

7. There are no special circumstances that require the collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.6.

8. The Department notice was published in the Federal Register on May 30, 2014, Volume 79, No. 104, page 31182. No comments were received in response to this notice.

9. No payments or gifts to respondents have been made under this collection of information.

10. Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant

Records - VA (55VA26) contained in the Privacy Act Issuances, 2001 Compilation.

11. There are no questions of a sensitive nature.

12. Estimate of Information Collection Burden

a. Number of Respondents: 1,400.

b. Frequency of response: One-time.

c. Annual burden Hours: 350.

d. Estimated Completion Time: 15 minutes.

e. According to the U.S. Bureau of Labor Statistics Average Hourly Earnings, the cost to the respondent is $24, making the total cost to the respondents an estimated $8,400. (350 burden hours x $24 per hour)

13. This submission does not involve any recordkeeping costs.

14. Estimated Annualized Cost to the Federal Government

$ 12,698 Total estimated cost to the Government (Loan Guaranty Processing

Cost for FY 2014 (1,400 cases x 15 minutes x $36.28 per hour

average Loan Guaranty field salary))

15. There is no change in burden hours. The expiration date placeholder was added to the form.

16. Information collection is not for tabulation or publication purposes.

17. We are not seeking approval to omit the expiration date for OMB approval.

18. This submission does not contain any exceptions to the certification statement.

B. Collections of Information Employing Statistical Methods

1. The Veterans Benefits Administration does not collect information employing statistical methods.