Information Collection

VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons

IC 249464 under ICR 202109-2900-008 · OMB 2900-0903.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0903 can be found here:

2025-01-02 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VBA-26-0967-ARE VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons	Form and Instruction
VBA-26-0967-ARE CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBI VBA-26-0967-ARE.pdf	Form and Instruction
VBA-26-0967-ARE CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBI VBA-26-0967-ARE.pdf	Form and Instruction
VBA-26-0967a-ARE SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS VBA-26-0967a-ARE.pdf	Form and Instruction
VBA-26-0967a-ARE SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS VBA-26-0967a-ARE.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 and Instruction	VBA-26-0967-ARE	CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION	VBA-26-0967-ARE.pdf		Yes	Yes	Fillable Printable
Form and Instruction	VBA-26-0967a-ARE	SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS	VBA-26-0967a-ARE.pdf		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Loan Guaranty Fee Personnel and Program Participant RecordsâVA. (17VA26) contained in the Privacy Act Issuances 2014 Compilation

FR Citation: 87 FR 283

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	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

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.