Preliminary Independent Living (IL) Assessment (28-0791)

ICR 201412-2900-010

OMB: 2900-0681

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
44130 Modified
ICR Details
2900-0681 201412-2900-010
Historical Active 201207-2900-001
VA VBA-VRE-NK
Preliminary Independent Living (IL) Assessment (28-0791)
Revision of a currently approved collection   No
Regular
Approved without change 08/24/2015
Retrieve Notice of Action (NOA) 08/03/2015
  Inventory as of this Action Requested Previously Approved
08/31/2018 36 Months From Approved 12/31/2015
2,500 0 2,500
2,500 0 2,500
0 0 0

The VA Form 28-0791 will be used by Vocational Rehabilitation and Employment case managers while performing a preliminary evaluation of the Independent Living (IL) needs of veterans with severe disabilities.

US Code: 38 USC 3104(a) Name of Law: Scope of services and assistance
   US Code: 38 USC 3109 Name of Law: Entitlement to independent living services and assistance
   US Code: 38 USC 3120 Name of Law: Program of Independent Living
  
None

Not associated with rulemaking

  80 FR 33 02/19/2015
80 FR 133 07/13/2015
No

1
IC Title Form No. Form Name
Preliminary Independent Living (IL) Assessment VA Form 28-8739a, VA Form 28-0791 Preliminary Independent Living (IL) Assessment ,   Protection of Privacy Information Statement

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500 2,500 0 0 0 0
Annual Time Burden (Hours) 2,500 2,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$95,675
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@va.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/03/2015


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