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

Forms and Documents

Document Name	Status
2018-13100 30-day Federal Register Notice.pdf Supplementary Document	2018-07-27
Supporting Statement 2900-0132_ 09.26.18.docx Supporting Statement A	2018-09-27
2018-05853 60-day Federal Register Notice.pdf Supplementary Document	2018-04-06

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)) Other-Screenshots of Electronic Submission Systems	Modified

ICR Details

OMB Control No: 2900-0132	ICR Reference No: 201802-2900-009
Status: Active	Previous ICR Reference No: 201410-2900-011
Agency/Subagency: VA	Agency Tracking No: VBA-LGY-YA
Title: Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (VA Form 26-4555)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/28/2018
	Date Received in OIRA: 08/23/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved	09/30/2018
Responses	7,000	0	6,000
Time Burden (Hours)	1,167	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: VA form 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:
	83 FR 12655	03/22/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 28492	06/19/2018
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))	26-4555	Application in Acquiring Specially Adapted Housing or Special Home Adaptation

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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	7,000	6,000	0	1,000	0	0
Annual Time Burden (Hours)	1,167	1,000	0	167	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: The increase in burden is due to improved outreach efforts by Specially Adapted Housing staff. This has led to more Veterans being aware of the grant benefits available to them, as well as assistance in completing the application.

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Annual Cost to Federal Government: $33,600

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? 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: 08/23/2018

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