Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (26-0967) and Scoring Criteria for SAH Assistive Technology Grant (26-0967a)

Forms and Documents

Document Name	Status
Form VA Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants Form	New
2900-0967 and 0967a SupportStatement.doc Supporting Statement A	2015-10-27

IC Document Collections

IC ID	Document Title	Status
217632	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants Form	New

ICR Details

OMB Control No: 2900-0821	ICR Reference No: 201507-2900-006
Status: Historical Active	Previous ICR Reference No: 201406-2900-003
Agency/Subagency: VA	Agency Tracking No: VBA-LGY-NK
Title: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (26-0967) and Scoring Criteria for SAH Assistive Technology Grant (26-0967a)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/31/2015
	Date Received in OIRA: 10/27/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	36 Months From Approved
Responses	20	0	0
Time Burden (Hours)	40	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: 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 and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Responses.

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Authorizing Statute(s): PL: Pub.L. 111 - 275 203 Name of Law: Veterans Benefits Act of 2010
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO70	Final or interim final rulemaking	80 FR 55763	09/17/2015

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Federal Register Notices & Comments

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
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants	VA Form 26-0967a, VA Form 26-0967	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion ,   Scoring Criteria for Specially Adaptive Housing (SAH) Assistive Technology Grants

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ICR Summary of Burden

	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	20	0	0	20	0	0
Annual Time Burden (Hours)	40	0	0	40	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new information collection. There is an "increase in burden" because we adjusted the numbers from minutes to hours to be consistent throughout the request.

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Annual Cost to Federal Government: $1,934

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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? Uncollected

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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: 10/27/2015

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