Information Collection

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

IC 211804 under ICR 201406-2900-003 · OMB 2900-0821.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0821 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	Form
VA Form 26-0967 Certification Regardomg Debarment, Suspension, Ineligibi 26-0967(6-14).pdf www.va.gov/vaforms	Form

IC Title:

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	VA Form 26-0967	Certification Regardomg Debarment, Suspension, Ineligibilty and Voluntary Exclusion	26-0967(6-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
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.