Information Collection

Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904)

IC 28212 under ICR 200511-2900-010 · OMB 2900-0067.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0067 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA-21-4502				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,552	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,552	52	1,500
Annual IC Time Burden (Hours)	388	13	375
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.