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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

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:

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

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 %

	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

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.