Information Collection

Preliminary Independent Living (IL) Assessment

IC 44130 under ICR 201207-2900-001 · OMB 2900-0681.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0681 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 28-0791 Preliminary Independent Living (IL) Assessment	Form
28-0791 Preliminary Independent Living (IL) Assessment VBA-28-0791-ARE.pdf	Form

IC Title:

Preliminary Independent Living (IL) Assessment

Agency IC Tracking Number:

2900-0681

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.162 38 CFR 21.50 38 CFR 21.160

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	28-0791	Preliminary Independent Living (IL) Assessment	VBA-28-0791-ARE.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	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.