OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT UNDER 38 U.S.C. 3901-3904

ICR 199311-2900-009 · OMB 2900-0067 · Historical Active

Forms and Documents
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IC Document Collections
IC IDCollectionTypeStatusForm
146851 APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT UNDER 38 U.S.C. 3901-3904 Form Migrated
ICR Details
2900-0067 199311-2900-009
Historical Active 199012-2900-001
VA
APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT UNDER 38 U.S.C. 3901-3904
Extension without change of a currently approved collection   No
Regular
Approved without change 01/05/1994
Retrieve Notice of Action (NOA) 11/08/1993
  Inventory as of this Action Requested Previously Approved
03/31/1997 03/31/1997 03/31/1994
1,500 0 1,500
375 0 375
0 0 0
VA FORM 21-4502 IS USED TO GATHER NECESSARY INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE IN THE PURCHASE OF AN AUTOMOBILE OR OTHER CONVEYANCE AND THE NECESSARY ADAPTIVE EQUIPMENT. A CERTIFICA IS ISSUED IF ELIGIBILITY IS ESTABLISHED.
None
None
No
1
IC Title Form No. Form Name
APPLICATION FOR AUTOMOBILE OR OTHER CONVEYANCE AND ADAPTIVE EQUIPMENT UNDER 38 U.S.C. 3901-3904 VAF 21-4502
  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 1,500 1,500 0 0 0 0
Annual Time Burden (Hours) 375 375 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/08/1993