Applications for Motor Vehicle Adaptive Equipment and HISA Services

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-1394 APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE	Form	Modified	Available
Form 10-0103 VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations	Form	Modified	Available
Form 10-0103 Applications for Motor Vehicle Adaptive Equipment and HISA Services	Form	Modified	Repair queued
30-day FRN_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_published 0506024.pdf	Supplementary Document	Uploaded 2024-05-06	Repair queued
60-day FRN_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_pub 02282024.pdf	Supplementary Document	Uploaded 2024-02-28	Repair queued
SSA_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_updated May 2024.docx	Supporting Statement A	Uploaded 2024-05-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28432	Applications for Motor Vehicle Adaptive Equipment and HISA Services	Form	Modified	APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
28432	Applications for Motor Vehicle Adaptive Equipment and HISA Services	Form	Modified	VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations
28432	Applications for Motor Vehicle Adaptive Equipment and HISA Services	Form	Modified

ICR Details

OMB Control No: 2900-0188	ICR Reference No: 202402-2900-018
Status: Active	Previous ICR Reference No: 201708-2900-026
Agency/Subagency: VA	Agency Tracking No: 2900-0188
Title: Applications for Motor Vehicle Adaptive Equipment and HISA Services
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/06/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2027	36 Months From Approved
Responses	21,000	0	0
Time Burden (Hours)	2,750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Veterans Affairs (VA), through its Veterans Health Administration (VHA), administers medical services established by law. Title 38 U.S.C. Section 1701(6) includes prosthetic items within the scope of medical services. Title 38 U.S.C. Section 3901, 3902, 3903, 3904, and 1162 authorize the Secretary to provide each person eligible for a motor vehicle grant the adaptive equipment deemed necessary to ensure that the person will be able to operate the vehicle safely, in a manner consistent with the safety of others and to satisfy the applicable standards of licensure established by the state of residency. Further, VA provides assistance to Veterans applying for Home Improvements and Structural Alterations (HISA) grants. The Prosthetic Service determines eligibility, entitlement, and payment of individual claims for home improvements and structural alterations to accommodate a Veteran’s needs.

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Authorizing Statute(s): US Code: 38 USC 3904 Name of Law: Research and development
   US Code: 38 USC 1701(6) Name of Law: Definitions
   US Code: 38 USC 3902 Name of Law: Assistance for providing automobile and adaptive equipment
   US Code: 38 USC 3903 Name of Law: Limitations on assistance; special training courses
   US Code: 38 USC 3901 Name of Law: Definitions
   US Code: 38 USC 1162 Name of Law: Annual Clothing Allowance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 14740	02/28/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 37282	05/06/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Applications for Motor Vehicle Adaptive Equipment and HISA Services	10-1394, 10-0103	VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations ,   APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	21,000	0	0	-50,200	0	71,200
Annual Time Burden (Hours)	2,750	0	0	-2,988	0	5,738
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The burden hours have decreased since the last submission due to removal of some forms.

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Annual Cost to Federal Government: $28,905

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/06/2024

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