Information Collection

Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973

IC 242714 under ICR 202005-2900-011 · OMB 2900-0883.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0883 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0143A Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973	Form
10-0143A Statement of Assurance of Compliance with Section 504 of VA Form 10-0143A_Needs New OMB No and Expir Date.pdf www.va.gov/vaforms/	Form

IC Title:

Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 51

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	10-0143A	Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973	VA Form 10-0143A_Needs New OMB No and Expir Date.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 156

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	156	156
Annual IC Time Burden (Hours)	13	13
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.