Information Collection

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants

IC 217632 under ICR 201507-2900-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form VA Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants Form
VA Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibi 26-0967(10-15).pdf www.va.gov/vaforms Form
VA Form 26-0967a Scoring Criteria for Specially Adaptive Housing (SAH) As 26-0967a(10-15).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and Scoring Criteria for SAH Assistive Technology Grants	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 26-0967	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	26-0967(10-15).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 26-0967a	Scoring Criteria for Specially Adaptive Housing (SAH) Assistive Technology Grants	26-0967a(10-15).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION	FR Citation: 5 FR 1320

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	40	40
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.