Information Collection

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

IC 204870 under ICR 202603-2900-015 · OMB 2900-0793.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA form 10-0491 Academic Verification VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491c Annual VA Employment or Deferment Verification VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491d Obligated Service VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491e Evaluation and Recommendation Form VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491g Application VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form and Instruction
Form VA Form 10-0491h Notice of Expected Graduation VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491i Notice of Change (NOC) VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491j Request for Deferment VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
Form VA Form 10-0491k VA Scholarship Offer Response VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form
VA form 10-0491 Academic Verification VA Form 10-0491_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491c Annual VA Employment or Deferment Verification VA Form 10-0491c_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491d Obligated Service VA Form 10-0491d_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491e Evaluation and Recommendation Form VA Form 10-0491e_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491g Application VA Form 10-0491g_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form and Instruction
VA Form 10-0491h Notice of Expected Graduation VA Form 10-0491h_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491i Notice of Change (NOC) VA Form 10-0491i_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491j Request for Deferment VA Form 10-0491j_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form
VA Form 10-0491k VA Scholarship Offer Response VA Form 10-0491k_updated 2026_draft.pdf vaww.va.gov/vaforms/	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

VHA-2900-0793

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR Part 17 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA form 10-0491	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491c	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491d	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491e	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form and Instruction	VA Form 10-0491g	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491h	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491i	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491j	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable
Form	VA Form 10-0491k	http://vaww.va.gov/vaforms/	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974, as amended

FR Citation: 71 FR 60232

Number of Respondents: 2,050

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,050	2,050
Annual IC Time Burden (Hours)	8,017	8,017
Annual IC Cost Burden (Dollars)	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.

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