Information Collection

Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (28-1905)

IC 28099 under ICR 201708-2900-033 · OMB 2900-0014.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 28-1905 Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (28-1905)	Form
VA Form 28-1905 Authorization and Certification of Entrance or Reentranc 28-1905(2-5-2019).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0014 VBA-VR&E-DB

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.332 38 CFR 21.320 38 CFR 21.294 38 CFR 21.321 48 CFR 871.201-2 38 CFR 21.322

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 28-1905	Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status	28-1905(2-5-2019).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: 90,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	90,000	90,000
Annual IC Time Burden (Hours)	7,500	7,500
Annual IC Cost Burden (Dollars)	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.