View Information Collection (IC)

View Information Collection (IC)

IC Title:	Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant (Title 38 U.S.C. Section 2101(a) or 2101(b))	Agency IC Tracking Number:	2900-0132

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 1.576 38 CFR 3.809

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots of Electronic Submission Systems			VIP4555.pdf	https://vip.vba.va.gov/portal/VBAH/Home	Yes	Yes	Fillable Fileable
Other-Screen shots			EB4555.pdf	https://www.ebenefits.va.gov	Yes	Yes	Fillable Fileable
Form	VA Form 26-4555	Application in Acquiring Specially Adapted Housing or Special Home Adaptation	26-4555(7-14).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	6,000	0	0	1,842	0	4,158
Annual IC Time Burden (Hours)	1,000	0	0	307	0	693
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

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.