omb scoring criteria.pdf

SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS

OMB Control Number: 2900-0821 Respondent Burden: 1 hour Expiration Date: 12/31/2018

VA FORM

DEC 2015 26-0967a PAGE 1

(1) Describe how the new assistive technology is innovative:

IMPORTANT: Applicants for SAH Assistive technology grants must provide responses addressing the six criteria items shown below.

NOTE: If additional space is needed please attach separate sheet(s) and indicate item number with response.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., the authorized release of information to Congress when requested for statistical purposes) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is voluntary.

RESPONDENT BURDEN: We need this information to help determine whether VA requirements for a grant award are met. Title 38, U.S.C. section 2108, authorizes collection of this information. We estimate that you will need an average of 1 hour to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

www.reginfo.gov/public/do/PRAMain

PAGE 2 VA FORM 26-0967a, DEC 2015

SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(2) Explain how the new assistive technology will meet a specific, unmet need among eligible individuals:

PAGE 3 VA FORM 26-0967a, DEC 2015

(3) Explain how the new assistive technology is specifically designed to promote the ability of eligible individuals to live more independently:

PAGE 4 VA FORM 26-0967a, DEC 2015

(4) Describe the new assistive technology's concept, size and scope:

PAGE 5 VA FORM 26-0967a, DEC 2015

(5) Describe the implementation plan with major milestones for bringing the new assistive technology into production and to the market.

(Note - The milestones must be meaningful and achieveable within a specific timeframe):

PAGE 6 VA FORM 26-0967a, DEC 2015

(6) Explain what uniquely positions the technology grant applicant in the marketplace.

(Note - This can include a focus on the characteristics such as the economic reliability of the technology grant applicant, the technology grant applicant's status as a minority or veteran-owned business, or other characteristics that the technology grant applicant wants to include to show how it will help protect the interests of, or further the mission of the Department of Veterans Affairs (VA)):

OMB Control Number: 2900-0821 Respondent Burden: 1 hour Expiration Date: 12/31/2018 OMB Control Number 2900-0821, Respondent Burden: 1 hour, Expiration Date: XXXXXXX OMB Control Number 2900-0821, Respondent Burden: 1 hour, Expiration Date: XXXXXXX

VA FORM

DEC 2015

26-0967a

(1) Describe how the new assistive technology is innovative:

IMPORTANT: Applicants for SAH Assistive technology grants must provide responses addressing the six criteria items shown below.

..\logos\FORMLOGO.jpg Department of Veterans Affairs Logo Department of Veterans Affairs Logo NOTE: If additional space is needed please attach separate sheet(s) and indicate item number with response.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., the authorized release of information to Congress when requested for statistical purposes) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is voluntary.

RESPONDENT BURDEN: We need this information to help determine whether VA requirements for a grant award are met. Title 38, U.S.C. section 2108, authorizes collection of this information. We estimate that you will need an average of 1 hour to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 26-0967a, DEC 2015 SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(2) Explain how the new assistive technology will meet a specific, unmet need among eligible individuals:

VA FORM 26-0967a, DEC 2015 SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(3) Explain how the new assistive technology is specifically designed to promote the ability of eligible individuals to live more independently:

VA FORM 26-0967a, DEC 2015 SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(4) Describe the new assistive technology's concept, size and scope:

VA FORM 26-0967a, DEC 2015 SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(5) Describe the implementation plan with major milestones for bringing the new assistive technology into production and to the market.

(Note - The milestones must be meaningful and achieveable within a specific timeframe):

VA FORM 26-0967a, DEC 2015 SCORING CRITERIA FOR SAH ASSISTIVE TECHNOLOGY GRANTS (Continued)

(6) Explain what uniquely positions the technology grant applicant in the marketplace.

(Note - This can include a focus on the characteristics such as the economic reliability of the technology grant applicant, the technology grant applicant's status as a minority or veteran-owned business, or other characteristics that the technology grant applicant wants to include to show how it will help protect the interests of, or further the mission of the Department of Veterans Affairs (VA)):

M. Wiley 9-28-15

VBA

N. Kessinger Scoring Criteria for SAH Assistive Technology Grants 9-15

independently::

(Note - The milestones must be meaningful and achieveable within a specific timeframe)::

6. Explain what uniquely positions the technology grant applicant in the marketplace.

(Note - This can include a focus on the characteristics such as the economic reliability of the technology grant applicant, the technology grant applicant's status as a minority or veteran-owned business, or other characteristics that the technology grant applicant wants to include to show how it will help protect the interests of, or further the mission of the Department of Veterans Affairs (VA))::