Information Collection

Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b))

IC 28354 under ICR 201410-2900-011 · OMB 2900-0132.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0132 can be found here:

Documents and Forms

Document Name Document Type
VIP4555.pdf vip.vba.va.gov/portal/VBAH/Home Other-Screenshots of Electronic Subm
EB4555.pdf www.ebenefits.va.gov Other-Screen shots
VA Form 26-4555 Application in Acquiring Specially Adapted Housing or Sp 26-4555.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b))	Agency IC Tracking Number:	2900-0132

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.809 38 CFR 1.576

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots of Electronic Submission Systems			VIP4555.pdf	https://vip.vba.va.gov/portal/VBAH/Home	Yes	Yes	Fillable Fileable
Other-Screen shots			EB4555.pdf	https://www.ebenefits.va.gov	Yes	Yes	Fillable Fileable
Form	VA Form 26-4555	Application in Acquiring Specially Adapted Housing or Special Home Adaptation	26-4555.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: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,000	1,842	4,158
Annual IC Time Burden (Hours)	1,000	307	693
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.