Information Collection

State Cemetery Data Sheet and Cemetery Grant Documents

IC 28741 under ICR 201003-2900-011 · OMB 2900-0559.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0559 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA 40-0895-16 State Cemetery Data Sheet and Cemetery Grant Documents	Form
40-0241 State Cemetery Data VA40-0241 050508.pdf www.forms.va.gov/va/Internet/VARF/getformsharness.asp?formname=40-0241-form	Form and Instruction
VA 40-0895-11 Memorandum of Agreement VA40-0895-11.pdf	Form
VA 40-0895-10 Certification of Compliance VA40-0895-10.pdf	Form
VA 40-0895-16 State or Tribal Government Cemetery Plan Preparation VA40-0895-16.pdf	Form
VA Form 40-0895-8 Certification Regarding Drug-Free Workplace VA40-0895-8.pdf	Form
VA Form 40-0895-17 State or Tribal Government Cemetery Documentation of Gra VA40-0895-17 (2).pdf	Form
VA Form 40-0895-9 Certification Regarding Lobbying VA40-0895-9 (2).pdf	Form
VA Form 40-0895-12 Certification Regarding Debarment, Suspension, Ineligibi VA40-0895-12.pdf	Form
VA Form 40-0895-2 Certification with Provisions of the Davis-Bacon Act VA40-0895-2 (2).pdf	Form
VA Form 40-0895-13 Certification Regarding Documents and Information for St VA40-0895-13.pdf	Form
VA Form 40-0895-3 State or Tribal Government Cemetery Grants Service Space VA40-0895-3.pdf	Form
VA Form 40-0895-15 Certification of Cemetery Maintained in Accordance with VA40-0895-15.pdf	Form
VA Form 40-0895-6 Certification of State or Tribal Government Matching Arc VA40-0895-6.pdf	Form
VA Form 40-0895-7 Certification Regarding Debarment, Suspension and Other VA40-0895-7.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State Cemetery Data Sheet and Cemetery Grant Documents

Agency IC Tracking Number:

2900-0559

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 39

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA 40-0895-16	State or Tribal Government Cemetery Plan Preparation	VA40-0895-16.pdf		No		Printable Only
Form	VA Form 40-0895-8	Certification Regarding Drug-Free Workplace	VA40-0895-8.pdf		No		Printable Only
Form and Instruction	40-0241	State Cemetery Data	VA40-0241 050508.pdf	http://www.forms.va.gov/va/Internet/VARF/getformsharness.asp?formname=40-0241-form	Yes	No	Printable Only
Form	VA 40-0895-11	Memorandum of Agreement	VA40-0895-11.pdf		No		Printable Only
Form	VA 40-0895-10	Certification of Compliance	VA40-0895-10.pdf		No		Printable Only
Form	VA Form 40-0895-17	State or Tribal Government Cemetery Documentation of Grant Accomplishments	VA40-0895-17 (2).pdf		No		Printable Only
Form	VA Form 40-0895-9	Certification Regarding Lobbying	VA40-0895-9 (2).pdf		No		Printable Only
Form	VA Form 40-0895-12	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	VA40-0895-12.pdf		No		Printable Only
Form	VA Form 40-0895-2	Certification with Provisions of the Davis-Bacon Act	VA40-0895-2 (2).pdf		No		Printable Only
Form	VA Form 40-0895-13	Certification Regarding Documents and Information for State or Tribal Government Cemetery Construction Grants - Post Grant Requirements	VA40-0895-13.pdf		No		Printable Only
Form	VA Form 40-0895-3	State or Tribal Government Cemetery Grants Service Space Program Analysis - Buildings	VA40-0895-3.pdf		No		Printable Only
Form	VA Form 40-0895-15	Certification of Cemetery Maintained in Accordance with National Cemetery Administration Standards	VA40-0895-15.pdf		No		Printable Only
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	VA40-0895-6.pdf		No		Printable Only
Form	VA Form 40-0895-7	Certification Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions - (State or Tribal Government)	VA40-0895-7.pdf		No		Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 243

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	243	177	66
Annual IC Time Burden (Hours)	8,723	8,657	66
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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