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VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr

IC 204870 under ICR 202212-2900-003 · OMB 2900-0793.

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Information Collection (IC) Details

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VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr 2900-0793
 
Yes Modified
 
Required to Obtain or Retain Benefits
 
38 CFR Part 17  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA form 10-0491 HPSP/VIOMPSP Academic Verification vha-10-0491-fill (Academic Verification).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491a HPSP/VIOMPSP Addendum to Application vha-10-0491a-fill (Application Addendum).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491c HPSP/VIOMPSP Annual VA Employment Deferment Verification vha-10-0491c-fill (Annual Deferment).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491d HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement vha-10-0491d-fill (Education Program Completion).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491e HPSP/VIOMPSP Evaluation Recommendation Form vha-10-0491e-fill (Evaluation and Recommendation).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491f HPSP Agreement vha-10-0491f-fill (HPSP Agreement)_revised per OMB passback_Feb 2020.pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form and Instruction VA Form 10-0491g HPSP/VIOMPSP Application vha-10-0491g-fill (Application).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491h HPSP/VIOMPSP Notice of Approaching Graduation vha-10-0491h-fill (Notice of Approaching Graduation).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491i HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report vha-10-0491i-fill (Notice of Change).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491j HPSP/VIOMPSP Request for Deferment for Advanced Education vha-10-0491j-fill (Deferment).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491k HPSP/VIOMPSP VA Scholarship Offer Response vha-10-0491k-fill (Offer Response).pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491L VIOMPSP Agreement vha-10-0491L-fill (VIOMPSP Agreement)_revised per OMB passback_Feb 2020.pdf http://vaww.va.gov/vaforms/ Yes Yes Fillable Printable
Form VA Form 10-0491m HPSP/VIOMPSP Mobility Agreement vha-10-0491m-fill (Mobility Agreement).pdf Yes Yes Fillable Printable
Form VA Form 10-0491n HPSP VHVMAESP Agreement vha-10-0491n-fill (VHVMAESP Agreement)_revised per OMB passback_Feb 2020.pdf Yes Yes Fillable Printable

Health Health Care Services

Privacy Act of 1974, as amended   71 FR 60232

1,950 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,950 0 150 0 0 1,800
Annual IC Time Burden (Hours) 7,619 0 623 0 0 6,996
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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