Applications for Motor Vehicle Adaptive Equipment and HISA Services

OMB 2900-0188

OMB 2900-0188

Used to determine eligibility, prescribe, authorize and pay for prosthetic devices and glasses, obtain estimates, allow direct purchase and obtain information on loaned devices.

The latest form for Applications for Motor Vehicle Adaptive Equipment and HISA Services expires 2020-12-31 and can be found here.

All Historical Document Collections
Approved without change
Reinstatement with change of a previously approved collection 2024-05-06
Approved without change
Revision of a currently approved collection 2017-10-31
Approved without change
Extension without change of a currently approved collection 2014-08-25
Withdrawn and continue
Revision of a currently approved collection 2014-03-13
Approved without change
Extension without change of a currently approved collection 2010-12-21
Approved without change
No material or nonsubstantive change to a currently approved collection 2009-10-05
Approved without change
Extension without change of a currently approved collection 2007-11-01
Approved without change
Extension without change of a currently approved collection 2004-09-02
Approved without change
Extension without change of a currently approved collection 2001-08-10
Approved without change
Revision of a currently approved collection 1998-11-16
Approved without change
Extension without change of a currently approved collection 1998-03-12
Approved without change
Reinstatement without change of a previously approved collection 1995-08-23
Approved without change
Revision of a currently approved collection 1991-12-06
Approved without change
Revision of a currently approved collection 1990-09-21
Approved without change
Reinstatement with change of a previously approved collection 1988-05-10
Approved with change
No material or nonsubstantive change to a currently approved collection 1985-10-01
Approved with change
No material or nonsubstantive change to a currently approved collection 1985-07-16
Approved without change
Reinstatement with change of a previously approved collection 1985-03-20
Approved with change
No material or nonsubstantive change to a currently approved collection 1984-09-25
Approved without change
Revision of a currently approved collection 1981-10-15
Approved with change
No material or nonsubstantive change to a currently approved collection 1981-04-09
Approved without change
Revision of a currently approved collection 1977-10-14
Approved with change
No material or nonsubstantive change to a currently approved collection 1977-06-27
Approved with change
No material or nonsubstantive change to a currently approved collection 1977-01-24

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