26-0967 OMB Justification (3)

VA Form 26-0967

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (Documents and Information Required for Specially Adapted Housing Assistive Technology Grant)

A. Justification

1. Section 203 of the Veterans’ Benefits Act of 2010, Public Law 111-275, amended 38 U.S.C. chapter 21 to establish the Specially Adapted Housing (SAH) Assistive Technology Grant program. 38 U.S.C. 2108 states that a person or entity seeking an SAH technology grant shall submit an application for the grant in such form and manner as the Secretary shall specify. VA is publishing proposed regulations to outline the process, the criteria, and the priorities relating to the award of these research and development grants. The proposed regulations would require applicants to submit VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. These regulations would also require applicants to provide statements addressing six scoring criteria for grant awards as part of their application. Lastly, the proposed regulations would require that applicants submit Standard Form 424, Application for Federal Assistance, which is covered under an existing information collection (OMB Number: 4040-0004).

2. Non-Federal entities (state and local governments, and non-profit organizations), private entities, and individuals may submit this information to complete an application for the SAH Assistive Technology Grant program. Applicants may either obtain printed copies of the forms or electronically download the required forms. These forms and other required statements are then completed and the applications submitted to VA electronically through Grants.gov. The signed forms provide certification of compliance with VA grant requirements. VA will use all information summited by applicants, including the SF 424, VA Form 26-0967, and statements addressing scoring criteria, in its grant award process. The information will be used by Loan Guaranty personnel in deciding whether an applicant meets the requirements and satisfies the scoring criteria for award of an SAH Assistive Technology grant under 38 U.S.C. 2108.

3. Applicants for an SAH Assistive Technology grant will submit their applications to the Secretary via Grants.gov. Grants.gov provides a centralized location for federal agencies to post discretionary funding opportunities and grant seekers to find and apply for federal funding opportunities. Electronic submission through this centralized website will reduce the burden on applicants and VA and will improve consistency in submissions. VA will use the information contained in Standard Form 424, VA Form 26-0967, and applicants’ statements addressing how their application meets the grant award scoring criteria, in its grants award process. These forms will be accessed and downloaded at the One-VA Forms Site (http://vaww4.va.gov/vaforms/) and Grants.gov (http://www.grants.gov). These signed forms will provide applicant certification of compliance with VA grant requirements. VA will use this information to award SAH Assistive Technology grants.

4. The information to be collected is unique to VA and is not duplicated in other agencies' records or in other VA records.

5. The collection of information will affect non-Federal entities, private entities, and individuals who chose to submit applications for the SAH Assistive Technology grant. This information collection is limited to determining whether, and to what degree, the applicant meets the requirements used in the award process of SAH Assistive Technology grants. Applicants may only apply for one grant per year, and once per project, in the maximum amount of $200,000 per project. Therefore this information is considered to only be collected one time, and may be submitted electronically, which lessens the burden on any small businesses or other small entities who choose to submit applications.

6. This information is collected only when a non-Federal entity, private entity, or individual wishes to apply for a SAH Assistive Technology grant. This information is essential the SAH Assistive Technology grant applications, the form and manner of which the Secretary is describing in proposed regulations pursuant to 38 U.S.C. 2108. The collection is generally conducted only one time, at the time of application submission. If this information was collected less frequently, VA would be unable to adequately assess applications or perform its statutory obligation to administer the program.

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. This information collection request is associated with a proposed rule, entitled “Loan Guaranty-Specially Adapted Housing Assistive Technology Grant Program,” that was published in the Federal Register on September 8, 2014, Volume 79, No. 173, page/pages 53146 - 53151. VA proposed these regulations to implement a new grant program to encourage the development of specially adapted housing assistive technologies. These proposed regulations outline the process, the criteria, and the priorities relating to the award of these research and development grants. Specific to this information collection, these proposed regulations would require that applicants explain how their grant proposals meet specific scoring criteria used to evaluate all technology grant applications received by VA and to certify that they are not currently suspended or debarred from participation in this transaction by any Federal department. No comments have been received in response to this proposed rule.

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

10. Loan Guaranty Fee Personnel and Program Participant Records—VA. (17VA26) contained in the Privacy Act Issuances, 2001 Compilation.

11. There are no questions of a sensitive nature.

12. Estimate of Information Collection Burden

a. VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion.

1. Number of Respondents: 20

2. Frequency of response: Once annually

3. Annual burden Hours: 20

4. Estimated Completion Time: 60 minutes

b. Applicant Scoring Criteria

1. Number of Respondents: 20

2. Frequency of response: Once annually

3. Annual burden Hours: 40

4. Estimated Completion Time: 120 minutes

c. According to the U.S. Bureau of Labor Statistics Average Hourly Earnings, the cost to the respondent is $15, making the total cost to the respondents an estimated $900. (60 burden hours x $15 per hour)

13. This submission does not involve any recordkeeping costs.

14. Estimated Annualized Cost to the Federal Government

$ 1723.6 Total estimated cost to the Government (Loan Guaranty Processing

Cost for FY 2014 (20 cases x 120 minutes x $43.09 per hour

average Loan Guaranty Central Office salary))

$0_____ Printing Costs

$1723.6

15. This is a new collection and there is no burden hour change.

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.