Information Collection

VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr

IC 204870 under ICR 201604-2900-017 · OMB 2900-0793.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0793 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA form 10-0491 HPSP/VIOMPSP Academic Verification VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491a HPSP/VIOMPSP Addendum to Application VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491c HPSP/VIOMPSP Annual VA employment deferment Verification VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491d HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491e HPSP/VIOMPSP Evaluation Recommendation Form VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491f HPSP Agreement VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491g HPSP/VIOMPSP Application VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form and Instruction
Form VA Form 10-0491h HPSP/VIOMPSP Notice of Approaching Graduation VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491i HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491j HPSP/VIOMPSP Request for Deferment for Advanced Education VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491k HPSP/VIOMPSP VA Scholarship Offer Response VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491L VIOMPSP Agreement VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
VA form 10-0491 HPSP/VIOMPSP Academic Verification vha-10-0491-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491a HPSP/VIOMPSP Addendum to Application vha-10-0491a-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491c HPSP/VIOMPSP Annual VA employment deferment Verification vha-10-0491c-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491d HPSP/VIOMPSP Education Program Completion Notice_Service vha-10-0491d-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491e HPSP/VIOMPSP Evaluation Recommendation Form vha-10-0491e-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491f HPSP Agreement vha-10-0491f-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491g HPSP/VIOMPSP Application vha-10-0491g-fill.pdf vaww.va.gov/vaforms/	Form and Instruction
VA Form 10-0491h HPSP/VIOMPSP Notice of Approaching Graduation vha-10-0491h-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491i HPSP/VIOMPSP Notice of Change and/or Annual Academic Sta vha-10-0491i-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491j HPSP/VIOMPSP Request for Deferment for Advanced Educatio vha-10-0491j-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491k HPSP/VIOMPSP VA Scholarship Offer Response vha-10-0491k-fill.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491L VIOMPSP Agreement vha-10-0491L-fill.pdf vaww.va.gov/vaforms/	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR Part 17 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA form 10-0491	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491a	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491c	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491d	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491e	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491f	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form and Instruction	VA Form 10-0491g	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491h	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491i	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491j	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491k	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable
Form	VA Form 10-0491L	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,500	0	6,500
Annual IC Time Burden (Hours)	24,342	-8,347	32,689
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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