Preliminary Independent Living (IL) Assessment

Preliminary Independent Living (IL) Assessment (28-0791)

OMB: 2900-0681

IC ID: 44130

Information Collection (IC) Details

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Preliminary Independent Living (IL) Assessment
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 21.50 38 CFR 21.160 38 CFR 21.162

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 28-0791 Preliminary Independent Living (IL) Assessment 28-0791(1-15).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 28-8739a Protection of Privacy Information Statement 28-8739a.pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

 

2,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,500 0 0 0 0 2,500
Annual IC Time Burden (Hours) 2,500 0 0 0 0 2,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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