Information Collection

State Cemetery Data Sheet and Cemetery Grant Documents

IC 28741 under ICR 201911-2900-008 · OMB 2900-0559.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0559 can be found here:

2023-09-14 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form 40-0241 State Cemetery Data Sheet and Cemetery Grant Documents Form and Instruction
40-0241 State Cemetery Data VA40-0241 2017.pdf www.forms.va.gov/va/Internet/VARF/getformsharness.asp?formname=40-0241-form Form and Instruction
VA 40-0895-10 Certification of Compliance VA40-0895-10 2017.pdf Form
VA 40-0895-16 State or Tribal Government Cemetery Plan Preparation VA40-0895-16 2017.pdf Form
VA Form 40-0895-8 Certification Regarding Drug-Free Workplace VA40-0895-8 2017.pdf Form
VA Form 40-0895-17 State or Tribal Government Cemetery Documentation of Gra VA40-0895-17 2017.pdf Form
VA Form 40-0895-9 Certification Regarding Lobbying VA40-0895-9 2017.pdf Form
VA Form 40-0895-12 Certification Regarding Debarment, Suspension, Ineligibi VA40-0895-12 2017.pdf Form
VA Form 40-0895-2 Certification with Provisions of the Davis-Bacon Act VA40-0895-2 2017.pdf Form
VA Form 40-0895-13 Certification Regarding Documents and Information for St VA40-0895-13 2017.pdf Form
VA Form 40-0895-3 State or Tribal Government Cemetery Grants Service Space VA40-0895-3 2017.pdf Form
VA Form 40-0895-15 Certification of Cemetery Maintained in Accordance with VA40-0895-15 2017.pdf Form
VA Form 40-0895-6 Certification of State or Tribal Government Matching Arc VA40-0895-6 2017.pdf Form
VA Form 40-0895-7 Certification Regarding Debarment, Suspension and Other VA40-0895-7 2017.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Cemetery Data Sheet and Cemetery Grant Documents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 39

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	40-0241	State Cemetery Data	VA40-0241 2017.pdf	http://www.forms.va.gov/va/Internet/VARF/getformsharness.asp?formname=40-0241-form	Yes	No	Printable Only
Form	VA 40-0895-10	Certification of Compliance	VA40-0895-10 2017.pdf		No		Printable Only
Form	VA 40-0895-16	State or Tribal Government Cemetery Plan Preparation	VA40-0895-16 2017.pdf		No		Printable Only
Form	VA Form 40-0895-8	Certification Regarding Drug-Free Workplace	VA40-0895-8 2017.pdf		No		Printable Only
Form	VA Form 40-0895-17	State or Tribal Government Cemetery Documentation of Grant Accomplishments	VA40-0895-17 2017.pdf		No		Printable Only
Form	VA Form 40-0895-9	Certification Regarding Lobbying	VA40-0895-9 2017.pdf		No		Printable Only
Form	VA Form 40-0895-12	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion	VA40-0895-12 2017.pdf		No		Printable Only
Form	VA Form 40-0895-2	Certification with Provisions of the Davis-Bacon Act	VA40-0895-2 2017.pdf		No		Printable Only
Form	VA Form 40-0895-13	Certification Regarding Documents and Information for State or Tribal Government Cemetery Construction Grants - Post Grant Requirements	VA40-0895-13 2017.pdf		No		Printable Only
Form	VA Form 40-0895-3	State or Tribal Government Cemetery Grants Service Space Program Analysis - Buildings	VA40-0895-3 2017.pdf		No		Printable Only
Form	VA Form 40-0895-15	Certification of Cemetery Maintained in Accordance with National Cemetery Administration Standards	VA40-0895-15 2017.pdf		No		Printable Only
Form	VA Form 40-0895-6	Certification of State or Tribal Government Matching Architectural and Engineering Funds to Qualify for Group 1 on the Priority List	VA40-0895-6 2017.pdf		No		Printable Only
Form	VA Form 40-0895-7	Certification Regarding Debarment, Suspension and Other Responsibility Matters Primary Covered Transactions - (State or Tribal Government)	VA40-0895-7 2017.pdf		No		Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 286	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	286	0	286
Annual IC Time Burden (Hours)	610	-9,440	10,050
Annual IC Cost Burden (Dollars)	0	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.