Applicant Scoring Criteria and Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (26-0967)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	Form	New	Available
26-0967 OMB Justification (3).doc	Supporting Statement A	Uploaded 2014-09-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213207	Applicant Scoring Criteria	Other-Open Response Questions	New
211804	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	Form	New

ICR Details

OMB Control No: 2900-0821	ICR Reference No: 201406-2900-003
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-NEW VBA-LGY-NK
Title: Applicant Scoring Criteria and Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (26-0967)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 09/30/2014
	Date Received in OIRA: 08/18/2014
Terms of Clearance: VA will resubmit the information collection request to OMB prior to the publication of the final rule.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: 38 U.S.C. 2108 states that a person or entity seeking an SAH technology grant shall submit an application for the grant in such form and manner as the Secretary shall specify. VA is publishing proposed regulations to outline the process, the criteria, and the priorities relating to the award of these research and development grants. The proposed regulations would require applicants to submit VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion. These regulations would also require applicants to provide statements addressing six scoring criteria for grant awards as part of their application. The information will be used by Loan Guaranty personnel in deciding whether an applicant meets the requirements and satisfies the scoring criteria for award of an SAH Assistive Technology grant under 38 U.S.C. 2108.

---

Authorizing Statute(s): PL: Pub.L. 111 - 275 203 Name of Law: Veterans Benefits Act of 2010
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO70	Proposed rulemaking	79 FR 53146	09/08/2014

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Applicant Scoring Criteria
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	VA Form 26-0967	Certification Regardomg Debarment, Suspension, Ineligibilty and Voluntary Exclusion

---

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: This is a new collection based on a proposed regulation. The total number of respondents was reached by taking into consideration that the total amount disbursed for the grants is capped.

---

Annual Cost to Federal Government: $1,723

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: 08/18/2014

---