APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT

ICR 198101-2900-021

OMB: 2900-0067

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2900-0067 198101-2900-021
Historical Active 197703-2900-007
VA
APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/22/1981
Approved with change 01/22/1981
Retrieve Notice of Action (NOA) 01/22/1981
  Inventory as of this Action Requested Previously Approved
03/31/1982 03/31/1982 03/31/1982
1,500 0 4,500
375 0 1,125
0 0 0

THIS APPLICATION IS REQUIRED FOR COMPLETION BY THE VETERAN OR SERVICE PERSON WHO IS FILING A CLAIM FOR AN AUTOMOBILE OR ADAPTIVE THE CLAIMANT'S DATA IS REQUIRED TO ESTABLISH ELIGIBILITY AND THE FORM IS USED TO IDENTIFY, IF ENTITLED THE SPECIFIC DISABILITY SO THAT THE APPROPRIATE AUTHORIZATION IS GRANTED. THE FORM IS ALSO USED TO NOTIFY THE VA OF RECEIPT OF THE VEHICLE ONCE AUTHORIZATION HAS BEEN GRANTED. AUTHORITY IS 38 U.S.C. CHAPTER 39, 38 C.F.R. 3.808

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT 21-4502

  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 1,500 4,500 0 -3,000 0 0
Annual Time Burden (Hours) 375 1,125 0 -750 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/22/1981


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