State Cemetery Data Sheet and Cemetery Grant Documents

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 40-0895-7 Certification Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions - (State or Tribal Government)	Form	Modified	Available
Form VA Form 40-0895-6 Certification of State or Tribal Government Matching Architectural and Engineering Funds to Qualify for Group 1 on the Priority List	Form	Modified	Available
Form VA Form 40-0895-15 Certification of Cemetery Maintained in Accordance with National Cemetery Administration Standards	Form	Modified	Available
Form VA Form 40-0895-3 State or Tribal Government Cemetery Grants Service Space Program Analysis - Buildings	Form	Modified	Available
Form VA Form 40-0895-13 Certification Regarding Documents and Information for State or Tribal Government Cemetery Construction Grants - Post Grant Requirements	Form	Modified	Available
Form VA Form 40-0895-2 Certification with Provisions of the Davis-Bacon Act	Form	Modified	Repair queued
Form VA Form 40-0895-12 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	Form	Modified	Available
Form VA Form 40-0895-9 Certification Regarding Lobbying	Form	Modified	Available
Form VA Form 40-0895-17 State or Tribal Government Cemetery Documentation of Grant Accomplishments	Form	Modified	Available
Form VA Form 40-0895-8 Certification Regarding Drug-Free Workplace	Form	Modified	Available
Form VA 40-0895-10 Certification of Compliance	Form	Modified	Available
Form VA 40-0895-11 Memorandum of Agreement	Form	Modified	Available
Form 40-0241 State Cemetery Data	Form and Instruction	Modified	Available
Form VA 40-0895-16 State or Tribal Government Cemetery Plan Preparation	Form	Modified	Available
2900-0559 justification 71210.doc	Supporting Statement A	Uploaded 2010-07-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions - (State or Tribal Government)
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification of State or Tribal Government Matching Architectural and Engineering Funds to Qualify for Group 1 on the Priority List
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification of Cemetery Maintained in Accordance with National Cemetery Administration Standards
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	State or Tribal Government Cemetery Grants Service Space Program Analysis - Buildings
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification Regarding Documents and Information for State or Tribal Government Cemetery Construction Grants - Post Grant Requirements
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification with Provisions of the Davis-Bacon Act
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification Regarding Lobbying
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	State or Tribal Government Cemetery Documentation of Grant Accomplishments
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification Regarding Drug-Free Workplace
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Certification of Compliance
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	Memorandum of Agreement
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form and Instruction	Modified	State Cemetery Data
28741	State Cemetery Data Sheet and Cemetery Grant Documents	Form	Modified	State or Tribal Government Cemetery Plan Preparation

ICR Details

OMB Control No: 2900-0559	ICR Reference No: 201003-2900-011
Status: Historical Active	Previous ICR Reference No: 200805-2900-003
Agency/Subagency: VA	Agency Tracking No: 2900-0559
Title: State Cemetery Data Sheet and Cemetery Grant Documents
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/29/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/15/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	36 Months From Approved	08/31/2010
Responses	243	0	66
Time Burden (Hours)	8,723	0	66
Cost Burden (Dollars)	0	0	0

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Abstract: Information is used by the State Cemetery Grants Service to provide data regarding the number of interments conducted at State veterans cemeteries and support grant applications each year. This data is necessary for budget and oversight purposes.

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Authorizing Statute(s): US Code: 38 USC Section 2408 Name of Law: Aid to States for establishing, expanding and improving veterans' cemeteries
   PL: Pub.L. 110 - 157 202b Name of Law: Dr. James Allen Veteran Vision Equity Act of 2007
   US Code: 38 USC 501 Name of Law: Rules and regulations
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AM96	Final or interim final rulemaking	75 FR 34004	06/16/2010

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
State Cemetery Data Sheet and Cemetery Grant Documents	VA 40-0895-16, VA Form 40-0895-12, VA Form 40-0895-3, VA Form 40-0895-2, VA Form 40-0895-15, VA 40-0895-11, VA Form 40-0895-17, VA Form 40-0895-8, VA Form 40-0895-9, VA Form 40-0895-13, VA 40-0895-10, VA Form 40-0895-7, VA Form 40-0895-6, 40-0241	State Cemetery Data ,   Memorandum of Agreement ,   Certification of Compliance ,   State or Tribal Government Cemetery Plan Preparation ,   Certification Regarding Drug-Free Workplace ,   State or Tribal Government Cemetery Documentation of Grant Accomplishments ,   Certification Regarding Lobbying ,   Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion ,   Certification with Provisions of the Davis-Bacon Act ,   Certification Regarding Documents and Information for State or Tribal Government Cemetery Construction Grants - Post Grant Requirements ,   State or Tribal Government Cemetery Grants Service Space Program Analysis - Buildings ,   Certification of Cemetery Maintained in Accordance with National Cemetery Administration Standards ,   Certification of State or Tribal Government Matching Architectural and Engineering Funds to Qualify for Group 1 on the Priority List ,   Certification Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions - (State or Tribal Government)

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ICR Summary of Burden

table that charts list of burden

	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	243	66	0	177	0	0
Annual Time Burden (Hours)	8,723	66	0	8,657	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden hours is due to the inclusion of the Cemetery Grant Documents forms and number of respondents for VA Form 40-0241.

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Annual Cost to Federal Government: $6,804

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/15/2010

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