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Applications for Motor Vehicle Adaptive Equipment and HISA Services
Applications for Motor Vehicle Adaptive Equipment and HISA Services
OMB: 2900-0188
IC ID: 28432
OMB.report
VA
OMB 2900-0188
ICR 202402-2900-018
IC 28432
( )
Documents and Forms
Document Name
Document Type
Form 10-0103
Applications for Motor Vehicle Adaptive Equipment and HISA Services
Form
10-0103 VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Im
VA Form 10-0103_updated May 2024.pdf
www.va.gov/vaforms
Form
10-0103 VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Im
VA Form 10-0103_updated May 2024.pdf
www.va.gov/vaforms
Form
10-1394 APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
VA Form 10-1394_updated May 2024.pdf
www.va.gov/vaforms
Form
10-1394 APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
VA Form 10-1394_updated May 2024.pdf
www.va.gov/vaforms
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Applications for Motor Vehicle Adaptive Equipment and HISA Services
Agency IC Tracking Number:
2900-0188
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
38 CFR 17
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
10-0103
VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations
VA Form 10-0103_updated May 2024.pdf
www.va.gov/vaforms
Yes
No
Fillable Printable
Form
10-1394
APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
VA Form 10-1394_updated May 2024.pdf
www.va.gov/vaforms
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:
21,000
Number of Respondents for Small Entity:
1
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
21,000
0
-50,200
0
71,200
0
Annual IC Time Burden (Hours)
2,750
0
-2,988
0
5,738
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.
