Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (21-4502)

ICR 201401-2900-007

OMB: 2900-0067

Federal Form Document

ICR Details
2900-0067 201401-2900-007
Historical Inactive 201107-2900-005
VA 2900-0067 VBA-COMP-NK
Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (21-4502)
Revision of a currently approved collection   No
Regular
Withdrawn and continue 03/11/2014
Retrieve Notice of Action (NOA) 02/28/2014
Terms of the previous clearance remain in effect. VA has requested withdrawal of this information collection request.
  Inventory as of this Action Requested Previously Approved
01/31/2015 36 Months From Approved 01/31/2015
1,552 0 1,552
388 0 388
0 0 0

VA Form 21-4502 is used to gather information that is necessary to determine the entitlement of veterans and servicepersons to automobile and adaptive equipment benefits. Without this information, VA would be unable to properly authorize benefits. This form is associated with the AO81 proposed rule.

US Code: 38 USC 3901 Name of Law: Definitions
   US Code: 38 USC 3902 Name of Law: Assistance for providing automobile and adaptive equipment
   US Code: 38 USC 3903 Name of Law: Limitations on assistance; special training courses
   US Code: 38 USC 3904 Name of Law: Research and development
  
None

2900-AO81 Proposed rulemaking 78 FR 211 10/31/2013

No

No
No

$63,980
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/28/2014


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