Information Collection

Conflicting Interests Certification for Proprietary Schools Only

IC 28934 under ICR 202006-2900-003 · OMB 2900-0657.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0657 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 22-1919 Conflicting Interests Certification for Proprietary Schools Only Form
VA Form 22-1919 Conflicting Interests Certification for Proprietary Scho 22-1919(6-15-20).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Conflicting Interests Certification for Proprietary Schools Only	Agency IC Tracking Number:	2900-0657

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.7122(e)(6) 38 CFR 21.7622(f)(4)(iv) 38 CFR 21.4202(c) 38 CFR 21.5200(c) 38 CFR 21.4200(z)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 22-1919	Conflicting Interests Certification for Proprietary Schools Only	22-1919(6-15-20).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: 58VA21/22/28, Compensation, Pension, Education, Vocational Rehabilitation and Employment Records - VA	FR Citation: 85 FR 18742

Number of Respondents: 336	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	336	134	202
Annual IC Time Burden (Hours)	56	22	34
Annual IC Cost Burden (Dollars)	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.