2900-0132SupportState

SUPPORTING STATEMENT FOR VA FORM 26-4555,

APPLICATION IN ACQUIRING SPECIALLY ADAPTED HOUSING OR SPECIAL HOME ADAPTATION GRANT

(2900-0132)

A. Justification

1. VA grants for Specially Adapted Housing (SAH) and Special Housing Adaptations (SHA) for disabled Veterans or Servicemembers are authorized under Title 38, U.S.C., chapter 21.

The Final Rule RIN 2900-AO81, Standard Claims and Appeals Forms, which requires all claims for benefits to be submitted on an application or form prescribed by the Secretary. VA is codifying its regulations to standardize the use of all VA forms, to include VA Form 26-4555.

2. VA Form 26-4555 is used to gather the necessary information to determine the eligibility for the SAH or SHA grant. The Veteran or Servicemember will complete VA Form 26-4555 and submit it to the nearest VA Regional Loan Center. VA will control the application, establish a file on the incoming forms, and forward them to the Veterans Service Center (VSC). VSC will process the forms and return them along with a rating decision to Loan Guaranty. Then Loan Guaranty will update the file and send the appropriate form letter to the Veteran or Servicemember notifying him or her of basic eligibility for the SAH or SHA benefit. The initial interview with the Veteran or Servicemember will be held within 30-business days for purposes of providing grant and related information.

3. Veterans and Servicemembers have the option to submit VA Form 26-4555 electronically through the eBenefits website at https://www.ebenefits.va.gov/. However, the electronic format requires additional information to be obtained from the Veteran or Servicemember. This information is required when the Veteran or Servicemember has no prior VA benefit claim established and is collected on behalf of Compensation and Pension (C&P) to facilitate processing a claim for SAH benefits. Since C&P may request additional information from the Veteran or Servicemember as needed during examination of the Veteran or Servicemember’s record, that same information is not collected on VA Form 26-4555. VA Form 26-4555 is also available through the One VA forms website at http://www.va.gov/vaforms in a fillable electronic format.

4. No duplication of information is involved. The electronic form solicits personal information from the Veteran and Servicemember that would not be available in another agency’s records. To the extent VA already has access to certain specific information pertaining to an individual applicant, eBenefits will pre-populate those specific items and it will not be necessary for an applicant to re-submit such information. However, if the information on record with VA or the Department of Defense (DoD) is incorrect or incomplete, individual applicants will need to provide certain specific information necessary to determine eligibility for SAH benefits.

5. Small business organizations are not involved.

6. Frequency is generally one-time per applicant. This information will be collected on an “as needed” basis. To the extent VA already has access to certain specific information pertaining to an individual applicant eBenefits will pre-populate those specific items and it will not be necessary for an applicant to re-submit such information. However, if the information on record with VA or DoD is incorrect or incomplete individual applicants will need to provide certain specific information necessary to determine eligibility for SAH benefits.

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 ( Insert Date ) (Volume___, No. ___) ( page/pages ) ( Insert Page Number(s) ). ( No or number ) comments were received in response to this notice.

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 questions of a sensitive nature are contained on the form.

12. Estimate of Information Collection Burden

a. The number of respondents is estimated at 6,000 per year. Online respondents account for 15% of this total.

b. Frequency of response is generally on occasion.

c. Annual burden is 1000 hours.

d. The estimated response time is 10 minutes.

e. According to the U.S. Bureau of Labor Statistics, Average Hourly Earnings are $24, making the total cost to the respondents an estimated $24,000.

13. This submission does not involve any recordkeeping costs.

14. Estimated Annualized Cost to the Federal Government

$ 35,920 Total estimated cost to the Government (Loan Guaranty processing cost for FY 2014 (6,000 cases x 10 minutes per case x $35.92 per hour average Loan Guaranty field salary))

15. The increase in burden hours is due to the rise in the number of respondents for SAH or SHA grants from 4,158 to 6,000 annually due to improved outreach campaigns.

The expiration date placeholder has been added to the form.

16. Information collection is not for publication purposes.

17. We are not seeking approval to omit the expiration date for OMB approval.

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

B. Collections of Information Employing Statistical Methods

1. The Veterans Benefits Administration does not collect information employing statistical methods.

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