APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE

ICR 198912-2900-001

OMB: 2900-0018

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2900-0018 198912-2900-001
Historical Active 198906-2900-016
VA
APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 02/02/1990
Retrieve Notice of Action (NOA) 12/29/1989
  Inventory as of this Action Requested Previously Approved
12/31/1992 12/31/1992
150 0 0
150 0 0
0 0 0

THIS FORM IS USED BY INDIVIDUALS TO APPLY FOR ACCREDITATION AS A SERVI ORGANIZATION REPRESENTATIVE. IT IS EXECUTED IN PART BY THE PROSPECTIVE APPOINTEE, COMPLETED BY AN OFFICIAL OF THE SERVICE ORGANIZATION, AND FORWARDED FOR APPROVAL BY THE GENERAL COUNSEL OF THE DEPARTMENT OF VETERANS AFFAIRS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE VA 2-21

  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 150 0 0 0 150 0
Annual Time Burden (Hours) 150 0 0 0 150 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$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.
12/29/1989


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