View Information Collection Request (ICR) Package
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Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
2900-0661
ICR Reference No:
201404-2900-021
Status:
Historical Active
Previous ICR Reference No:
201308-2900-029
Agency/Subagency:
VA
Agency Tracking No:
2900-0661
Title:
Forms for Grants to States for Construction and Acquisition of State Home Facilities
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/02/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/03/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2018
36 Months From Approved
01/31/2015
Responses
50
0
50
Time Burden (Hours)
1,200
0
1,200
Cost Burden (Dollars)
0
0
0
Abstract:
State Governments submit to the VA information and required documentation to apply for the State Home Construction Grant Program and to certify compliance with VA requirements.
Authorizing Statute(s):
US Code:
38 USC 8135(a)
Name of Law: Applications with respect to projects; payments
US Code:
38 USC 8133(a)
Name of Law: Authorization of appropriations
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
2900-AJ43
Final or interim final rulemaking
66 FR 123
06/26/2001
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 32822
06/06/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 53114
09/05/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities
10-0388-6, 10-0388-8, 10-388-9, 10-0388-10, 10-0388-1, 10-0388-2, 10-0388-3, 10-0388-4, 10-0388-7, 10-0388-5, 10-0388-13, 10-0388-12
Documents and Information Required for State Home Construction and Acquisition Grants - Initial Application
,
Certification of Compliance with Provisions of the Davis-Bacon Act
,
State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary
,
Sate Home Construction Grant Program Space Program Analysis - Adult Day Care
,
Additionall Documents and Information Required for State Home Construction and Acquisition Grants Application
,
Certification of State Matching Funds To Qualify for Group 1 on the Priority List
,
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
,
Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals
,
Certification Regarding Lobbying
,
Certification of Compliance With Federal Requirements - State Home Construction Grant
,
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions
,
Documents and Information Required for State Home Construction and Acquisition Grants - Post-Grant Requirements
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
50
50
0
0
0
0
Annual Time Burden (Hours)
1,200
1,200
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Crystal Rennie 202 632-7492 crystal.rennie@va.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
10/03/2014
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