OMB control number

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (VA Form 26-0967) & Specially Adaptive Housing Assist. Tech. Grants Criteria and Response (VA Form 26-0967a)

OMB 2900-0903 · VA.

OMB 2900-0903

Section 203 of the Veterans’ Benefits Act of 2010, Public Law 111-275, amended chapter 21, title 38, United States Code, to establish the Specially Adapted Housing (SAH) Assistive Technology Grant program. 38 U.S.C. 2108 states that a person or entity seeking an SAH technology grant shall submit an application for the grant in such form and manner as the Secretary shall specify. VA published regulations to outline the process, the criteria, and the priorities relating to the award of these research and development grants. 36 C.F.R. 4412(d)(2) requires applicants to submit VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Responses. 36 C.F.R. 4412(d)(3) require applicants to provide statements addressing six scoring criteria for grant awards as part of their application. Lastly, 36 C.F.R. 4412(d)(1) require that applicants submit Standard Form 424, Application for Federal Assistance, which is covered under an existing information collection (OMB Number: 4040-0004). The final rule was published on September 17, 2015 (80 FR 55763-55766).

The latest form for Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (VA Form 26-0967) & Specially Adaptive Housing Assist. Tech. Grants Criteria and Response (VA Form 26-0967a) expires 2028-02-29 and is listed under ICR 202407-2900-011.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 26-0967 Scoring Criteria for SAH Assistive Technology GrantsForm and Instruction
Form 26-0967 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary ExclusionForm and Instruction
Form 26-0967 VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and ResponsForm and Instruction
30-DAY (published) 2900-0903.pdfSupplementary Document
30-DAY (published) 2900-0903.pdf Supplementary Document
Public Comments Email 10272024.pdf (document unavailable)Public Comments
2900-0903 VA Form 26-0967 FRN.pdfSupplementary Document
2900-0903 VA Form 26-0967 FRN.pdf Supplementary Document
OMB 2900-0903 26-0967 & 26-0967a Support Stmt FINAL 12262024 (2).docxSupporting Statement A
OMB 2900-0903 26-0967 & 26-0967a Support Stmt FINAL 12262024 (2).docxSupporting Statement A
VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons Form and Instruction
VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons Form and Instruction
VA Form 26-0967, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, and VA Form 26-0967a, Specially Adaptive Housing Assistive Technology Grants Criteria and Respons Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202407-2900-011 Extension without change of a currently approved collection 2025-01-02
202109-2900-008 New collection (Request for a new OMB Control Number) 2022-01-12 Approved with change