Information Collection

Pre and Post Independent Living Assessment (VA Form 28-0791)

IC 44130 under ICR 202404-2900-018 · OMB 2900-0681.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 28-0791 Pre and Post Independent Living Assessment (VA Form 28-0791)	Form and Instruction
28-0791 Pre and Post Independent Living Assessment VBA-28-0791-ARE 6-6-24.pdf www.va.gov/vaforms	Form and Instruction
28-0791 Pre and Post Independent Living Assessment VBA-28-0791-ARE 6-6-24.pdf www.va.gov/vaforms	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.160 38 CFR 21.162 38 CFR 21.50

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	28-0791	Pre and Post Independent Living Assessment	VBA-28-0791-ARE 6-6-24.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: Compensation, Pension, Education and Veteran Readiness and Employment Records - VA

FR Citation: 87 FR 8740

Number of Respondents: 906

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	906	-1,594	2,500
Annual IC Time Burden (Hours)	906	-1,594	2,500
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.