OMB control number
Applications for Motor Vehicle Adaptive Equipment and HISA Services
OMB 2900-0188 · VA.
OMB 2900-0188
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.
The latest form for Applications for Motor Vehicle Adaptive Equipment and HISA Services expires 2027-06-30 and is listed under ICR 202402-2900-018.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 10-0103 Applications for Motor Vehicle Adaptive Equipment and HISA Services | Form |
| 30-day FRN_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_published 0506024.pdf | Supplementary Document |
 60-day FRN_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_pub 02282024.pdf | Supplementary Document |
 SSA_2900-0188_Applications for Motor Vehicle Adaptive Equipment and HISA Services_updated May 2024.docx | Supporting Statement A |
 Applications for Motor Vehicle Adaptive Equipment and HISA Services |
Form |