26-0967 Scoring Criteria for SAH Assistive Technology Grants

OMB Control Number: 2900-0903
Respondent Burden: 1 hour
Expiration Date: XX/XX/20XX

SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS
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Federal Regulations 1.576 for routine uses (i.e., the authorized release of information to Congress when requested for statistical purposes) as identified in the VA system of records, 55VA26,
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published in the Federal Register. Your obligation to respond is voluntary.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 2900-0903, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 1 hour per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance
Officer at [email protected]. Please refer to OMB Control No. 2900-0903 in any correspondence. Do not send your completed VA Form 26-0967a to this email address.

IMPORTANT: Applicants for SAH Assistive technology grants must provide responses addressing the six criteria items shown below.
NOTE: If additional space is needed please attach separate sheet(s) and indicate item number with response.

(1) Describe how the new assistive technology is innovative:

VA FORM
XXX 20XX

26-0967a

SUPERSEDES VA FORM 26-0967a, FEB 2022,
WHICH WILL NOT BE USED.

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SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)
(2) Explain how the new assistive technology will meet a specific, unmet need among eligible individuals:

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SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)
(3) Explain how the new assistive technology is specifically designed to promote the ability of eligible individuals to live more
independently:

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SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)
(4) Describe the new assistive technology's concept, size and scope:

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SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)
(5) Describe the implementation plan with major milestones for bringing the new assistive technology into production and to the market.
(Note - The milestones must be meaningful and achieveable within a specific timeframe):

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SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)
(6) Explain what uniquely positions the technology grant applicant in the marketplace.
(Note - This can include a focus on the characteristics such as the economic reliability of the technology grant applicant, the
technology grant applicant's status as a minority or veteran-owned business, or other characteristics that the technology grant
applicant wants to include to show how it will help protect the interests of, or further the mission of the Department of Veterans
Affairs (VA)):

VA FORM 26-0967a, XXX 20XX

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