Form 0896a VA Subcontracting Report for Service-Disabled Veteran-ow

OMB Approved No.
Respondents Burden: 2 Hours

VA SUBCONTRACTING REPORT
FOR SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS
AND
VETERAN-OWNED SMALL BUSINESS CONCERNS

PAPERWORK REDUCTION ACT NOTICE: The information collected on this form is in accordance with Public Law (P.L.) 109-461(a)(4), “The Secretary of the
Department of Veterans Affairs shall establish a review mechanism to ensure that, in the case of a subcontract of a Department contract that is counted for purposes of
meeting a goal established pursuant to this section, the subcontract was actually awarded to a business concern that may be counted for purposes of meeting that goal.”
In order to implement the review mechanism requirement, the Department of Veterans Affairs (VA), Office of Small and Disadvantaged Business Utilization (OSDBU)
will utilize a new VA Form 0896a to collect information from prime contractors.
The consequence of not implementing this new data collection process would be the failure of the VA to adhere to federal law. P.L. 109-461 specifically requires that the
VA review data that is currently not collected. This new data collection process would enable the OSDBU office to compile the data necessary to report on prime
contractor adherence to their approved subcontracting plan and to analyze reasons for deviations, conduct trend analysis, and to make recommendations to VA leadership
on how to improve subcontracting goal accomplishments. This will allow the VA OSDBU to comply with the “review mechanism” requirement of P.L. 109-461.
The collection of information meets the requirement of P.L. 109-461(a)(4). We estimate the time to fill out the form to be about 2 hours. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed.
Your obligation to respond to this form is mandatory.

INSTRUCTIONS: Please complete the information below and return to: Department of Veterans Affairs, Office of Small and Disadvantaged
Business Utilization (OOSB), 810 Vermont Avenue, N.W., Washington, DC 20420; or you can email to [email protected]
PRIME CONTRACTORS' INFORMATION

NAME AND ADDRESS OF PRIME CONTRACTOR
(Provide street, city, state, and ZIP code)

OFFICE TELEPHONE NO.

E-MAIL ADDRESS

NAME AND TITLE OF PERSON CERTIFYING INFORMATION

PRIME CONTRACTOR'S DUNS NO.

INDIVIDUAL RESPONSIBLE FOR CONTRACT

SIGNATURE OF CERTIFYING OFFICIAL

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS INFORMATION
NAME AND ADDRESS OF SUB CONTRACTOR
(Provide street, city, state, and ZIP code)

POINT OF CONTACT RESPONSIBLE FOR CONTRACT

OFFICE TELEPHONE NO.

SUBCONTRACTOR'S DUNS NO.

E-MAIL ADDRESS

PRIME CONTRACTOR'S DUNS NO.

IS COMPANY REGISTERED IN VENDOR INFORMATION PAGE VETBIZ DATABASE?

http://www.vip.vetbiz.gov
YES

DOLLAR AMOUNT AWARDED
FROM PRIME CONTRACTOR
LISTED ABOVE

NO

NAME AND TITLE OF PERSON CERTIFYING INFORMATION

SIGNATURE OF CERTIFYING OFFICIAL

$
VETERAN-OWNED SMALL BUSINESS INFORMATION
NAME AND ADDRESS OF SUB CONTRACTOR
(Provide street, city, state, and ZIP code)

OFFICE TELEPHONE NO.

SUBCONTRACTOR'S DUNS NO.

E-MAIL ADDRESS

PRIME CONTRACTOR'S DUNS NO.

POINT OF CONTACT RESPONSIBLE FOR CONTRACT

IS COMPANY REGISTERED IN VENDOR INFORMATION PAGE VETBIZ DATABASE?

http://www.vip.vetbiz.gov
YES

TOTAL DOLLAR AMOUNT OF
CONTRACT AWARDED FROM
PRIME CONTRACTOR

NAME AND TITLE OF PERSON CERTIFYING INFORMATION

NO
SIGNATURE OF CERTIFYING OFFICIAL

$

VA FORM
OCT 2009

0896A

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