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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904)

ICR 200511-2900-010 · OMB 2900-0067 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28212 Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904) Form Migrated
ICR Details
2900-0067 200511-2900-010
Historical Active 200211-2900-007
VA
Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904)
Extension without change of a currently approved collection   No
Regular
Approved without change 12/29/2005
Retrieve Notice of Action (NOA) 11/18/2005
Approved consistent with the following terms of clearance: in the next submission of this collection of information to OMB for review VA shall report on the feasibility of providing respondents with a fully electronic process for the completion and submission of associated forms.
  Inventory as of this Action Requested Previously Approved
12/31/2008 12/31/2008 12/31/2005
1,552 0 1,500
388 0 375
0 0 0
VA Form 21-4502 is used to gather information that is necessary to determine the entitlement of veterans and servicepersons to automobile and adaptive equipment benefits. Without this information, VA would be unable to properly authorize benefits.
None
None
No
1
IC Title Form No. Form Name
Application for Autmobile or Other Conveyance and Adaptive Equipment (Under 28 U.S.C. 3901-3904) VA-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 1,552 1,500 0 52 0 0
Annual Time Burden (Hours) 388 375 0 13 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
11/18/2005