OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Applications for Motor Vehicle Adaptive Equipment and HISA Services

OMB 2900-0188 · VA.

OMB 2900-0188

The Department of Veterans Affairs (VA), through its Veterans Health Administration (VHA), administers medical services established by law. Title 38 U.S.C. Section 1701(6) includes prosthetic items within the scope of medical services. Title 38 U.S.C. Section 3901, 3902, 3903, 3904, and 1162 authorize the Secretary to provide each person eligible for a motor vehicle grant the adaptive equipment deemed necessary to ensure that the person will be able to operate the vehicle safely, in a manner consistent with the safety of others and to satisfy the applicable standards of licensure established by the state of residency. Further, VA provides assistance to Veterans applying for Home Improvements and Structural Alterations (HISA) grants. The Prosthetic Service determines eligibility, entitlement, and payment of individual claims for home improvements and structural alterations to accommodate a Veteran’s needs.

The latest form for Applications for Motor Vehicle Adaptive Equipment and HISA Services expires 2027-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supplementary Document
Supplementary Document
Supporting Statement A
All Historical Document Collections
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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Withdrawn and continue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