Information Collection

Adaptive Sports Grant Application

IC 215772 under ICR 201501-2900-009 · OMB 2900-0845.

Documents and Forms

Document Name Document Type
Form VA 10096 Adaptive Sports Grant Application Form
VA 10096 Adaptive Sports Grant Application VA Form 10096_2015.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adaptive Sports Grant Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 77

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA 10096	Adaptive Sports Grant Application	VA Form 10096_2015.pdf	TBD	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 5 USC 7351	FR Citation: 38 FR 77

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	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.