Information Collection

Conflicting Interests Certification for Proprietary Schools Only

IC 28934 under ICR 201012-2900-003 · OMB 2900-0657.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0657 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 22-1919 Conflicting Interests Certification for Proprietary Schools Only	Form
VA Form 22-1919 Conflicting Interests Certification for Proprietary Scho 22-1919.pdf www.va.gov/vaforms	Form

IC Title:

Conflicting Interests Certification for Proprietary Schools Only

Agency IC Tracking Number:

2900-0657

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.7122(e)(6) 38 CFR 21.4200(z) 38 CFR 21.7622(f)(4)(iv) 38 CFR 21.4202(c) 38 CFR 21.5200(c)

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 Form 22-1919	Conflicting Interests Certification for Proprietary Schools Only	22-1919.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 631

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	631	481	150
Annual IC Time Burden (Hours)	105	80	25
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.