Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (VA Form 26-4555)

Forms and Documents

Document Name	Status
Form VA Form 26-4555 Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b)) Form	Modified
White Paper - VA 26-4555.docx Justification for No Material/Nonsubstantive Change	2022-02-18
30-Day FedRegNotice 2020 - OMB Control No. 2900-0132 v3.docx Supplementary Document	2022-02-17
60-Day FRN - 2900-0132 (VA Form 26-4555).pdf Supplementary Document	2022-02-17
Supporting Statement - 26-4555 (OMB #2900-0132) v2.docx Supporting Statement A	2022-02-17

IC Document Collections

IC ID	Document Title	Status
28354	Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b)) Form	Modified

ICR Details

OMB Control No: 2900-0132	ICR Reference No: 202202-2900-003
Status: Received in OIRA	Previous ICR Reference No: 202102-2900-012
Agency/Subagency: VA	Agency Tracking No: VBA-LGY-NK
Title: Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (VA Form 26-4555)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/18/2022

	Requested	Previously Approved
Expiration Date	06/30/2024	06/30/2024
Responses	2,000	2,000
Time Burden (Hours)	500	500
Cost Burden (Dollars)	0	0

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Abstract: VA Form 26-4555 is used to gather information necessary to determine the eligibility for the veteran or servicemember for specially adapted housing or for a special home adaptation grant.

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Authorizing Statute(s): US Code: 38 USC 2101 Name of Law: Veterans Eligible For Assistance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 10006	02/17/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22301	04/27/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b))	VA Form 26-4555	Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant

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ICR Summary of Burden

	Total Request	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	2,000	2,000	0	0	0	0
Annual Time Burden (Hours)	500	500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Estimated 2,000 SAH applications are submitted annually at 15 minutes burden time per application. Total annual burden time is estimated at 500 hours.

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Annual Cost to Federal Government: $18,020

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/18/2022

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