Information Collection

Conflicting Interests Certification for Proprietary Schools Only

IC 28934 under ICR 202312-2900-004 · OMB 2900-0657.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 22-1919 Conflicting Interests Certification for Proprietary Schools Only	Form
22-1919 Conflicting Interests Certification for Proprietary Scho VA Form 22-1919 (OMB Exp. 3-31-23).pdf www.va.gov/vaforms	Form
22-1919 Conflicting Interests Certification for Proprietary Scho VA Form 22-1919 - New Burden Statement (508 Conformant 3-8-24) 3-27-24.pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-0657

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.7122(e)(6) 38 CFR 21.7622(f)(4)(iv) 38 CFR 21.4202(c) 38 CFR 21.5200(c) 38 CFR 21.4200(z)

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	22-1919	Conflicting Interests Certification for Proprietary Schools Only	VA Form 22-1919 - New Burden Statement (508 Conformant 3-8-24) 3-27-24.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: Compensation, Pension, Education, Veteran Readiness and Employment Records - VA 58VA21/22/28

FR Citation: 84 FR 4138

Number of Respondents: 236

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	236	-100	336
Annual IC Time Burden (Hours)	39	-17	56
Annual IC Cost Burden (Dollars)	0	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.