Forms for Grants to States for Construction and Acquisition of State Home Facilities

Forms and Documents

Document Name	Status
10-0388-14 7-22-2013.pdf Supplementary Document	2013-08-13
2900-0661 justification_2014.docx Supporting Statement A	2014-12-29

IC Document Collections

IC ID	Document Title	Status
28939	Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities Other-Support List for State Home Construction Grant Forms (VA F	Modified

ICR Details

OMB Control No: 2900-0661	ICR Reference No: 201404-2900-021
Status: Historical Active	Previous ICR Reference No: 201308-2900-029
Agency/Subagency: VA	Agency Tracking No: 2900-0661
Title: Forms for Grants to States for Construction and Acquisition of State Home Facilities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/02/2015
	Date Received in OIRA: 10/03/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2018	36 Months From Approved	01/31/2015
Responses	50	0	50
Time Burden (Hours)	1,200	0	1,200
Cost Burden (Dollars)	0	0	0

---

Abstract: State Governments submit to the VA information and required documentation to apply for the State Home Construction Grant Program and to certify compliance with VA requirements.

---

Authorizing Statute(s): US Code: 38 USC 8135(a) Name of Law: Applications with respect to projects; payments
   US Code: 38 USC 8133(a) Name of Law: Authorization of appropriations
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AJ43	Final or interim final rulemaking	66 FR 123	06/26/2001

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 32822	06/06/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 53114	09/05/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities	10-0388-6, 10-0388-8, 10-388-9, 10-0388-10, 10-0388-12, 10-0388-13, 10-0388-1, 10-0388-2, 10-0388-3, 10-0388-4, 10-0388-7, 10-0388-5	Documents and Information Required for State Home Construction and Acquisition Grants - Initial Application ,   Certification of Compliance with Provisions of the Davis-Bacon Act ,   State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary ,   Sate Home Construction Grant Program Space Program Analysis - Adult Day Care ,   Additionall Documents and Information Required for State Home Construction and Acquisition Grants Application ,   Certification of State Matching Funds To Qualify for Group 1 on the Priority List ,   Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions ,   Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals ,   Certification Regarding Lobbying ,   Certification of Compliance With Federal Requirements - State Home Construction Grant ,   Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions ,   Documents and Information Required for State Home Construction and Acquisition Grants - Post-Grant Requirements

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50	50	0	0	0	0
Annual Time Burden (Hours)	1,200	1,200	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/03/2014

---