2900-0300 VAF 26-4555D(CRrev 051113) (3)

Supporting Statement for VA Form 26-4555d,

Veterans Application for Assistance in Acquiring

Special Housing Adaptations

(2900-0300)

A. JUSTIFICATION

1. Title 38, U.S.C. 2101 authorizes assistance to disabled Veterans in acquiring special housing and adaptations to dwellings. Under 38 U.S.C. 2101(b), grants are available to assist Veterans in making adaptations to their current residences or one which they intend to live in as long as the home is owned by the Veteran or a member of the Veteran's family. Personal interview questions associated with the grant program, as outlined in VBA Manual M26-12, Chapter 8.

2. VA Form 26-4555d is needed because of the difference in disabilities, the amount of alteration/adaptation to the house, and title requirements. In addition, the amount and type of information needed to process either benefit is different, and a separate numbering and filing system will be used to identify the different types of grants. The information contained on a completed VA Form 26-4555d enables field personnel to evaluate the request for adaptations. It also provides information for use in approving or disapproving a Veteran's application for a grant under 38 U.S.C. 2101(b). If the information was not collected, VA would be in noncompliance with 38 U.S.C. 2101(b).

3. VA Form 26-4445d is available on the One-VA web site in a fillable electronic format. Once a determination on eligibility is made and the file is reviewed by Loan Guaranty personnel, the Veteran or servicemember is directed to complete VA Form 26-4555d with instructions. An electronic submission system would not allow for personal customer service, and would delay applications from being processed due to errors. VA will continue to explore the use of information technology to submit this form.

4. No duplication of information is involved.

5. Collection of information does not involve small businesses or other small entities.

6. This information collection is not a recurring or repetitive report. It is accomplished on a one-time basis per individual applicant.

7. There are no special circumstances that require the collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.6.

8. The Department notice was published in the Federal Register on February 13, 2013, Volume 78, Number 30, at pages 10266-10267. No comments were received.

9. No payments or gifts to respondents have been made under this collection of information.

10. "Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA” (55VA26) contained in the Privacy Act Issuances, 2001 Compilation.

11. No sensitive questions appear on the form.

12. Estimate of Information Collection Burden

a. Number of respondents is estimated at 100 per year.

b. Frequency of response is generally one time.

c. Annual burden is estimated at 33 hours.

d. The estimated response time of 20 minutes per case is based on the experience of VA Central Office Loan Specialists.

e. The total estimated cost to respondents is $495 ($15 per hour x 33 hours).

13. This submission does not involve any recordkeeping costs.

13. Estimated Annualized Cost to the Federal Government

$908 Estimated Loan Guaranty processing cost for FY 2013:

(100 cases x 20 minutes per case x $27.24 per hour (average

Loan Guaranty field salary))

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$908 Total Estimated Cost to Federal Government

15. There is an increase in burden hours due to the rise in the number of Veterans applying for specially adapting housing grants.

16. Information collection is not for tabulation or publication use.

17. Not requesting exemption.

18. This submission does not contain any exceptions to the certification statement.

B. STATISTICAL METHODS

The data collection does not employ statistical methods.

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