Va Form 26-6681 - Application For Fee Or Roster Personnel Designation

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OMB Control No. 2900-0113

Respondent Burden: 30 Mins.

APPLICATION FOR FEE OR ROSTER

PERSONNEL DESIGNATION

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 (for example: Authorized for release of information to Congress when requested for statistical purposes) as

identified in the VA system of records, (17VA26), Loan Guaranty Fee Personnel and Program Participant Records-VA, and published in the Federal Register. Your

obligation to respond is mandatory. Giving us your SSN account information is mandatory. Applicants are required to provide their SSN under Chapter 37, Title 38 U.S.

C. VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior

to January 1, 1975, and still in effect.

RESPONDENT BURDEN: We need this information to enable VA to determine whether you qualify for designation in the position for which you are applying. Title

38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes 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

If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

PENALTY: Failure to provide any of the requested information could affect the decision to approve your application since this decision will be made only on the basis

of available information we currently have on record. This may result in a delay in the processing of your application.

INSTRUCTIONS: Please print clearly. Completed VA application may be submitted by e-mail or by mail to the VA Regional Loan Center of Jurisdiction.

ETHNICITY AND RACE: Please provide both ethnicity and race. For race, you may check more than one designation.

DESIGNATION BEING APPLIED FOR:

REAL ESTATE APPRAISER

COMPLIANCE INSPECTOR

(First, middle, last)

2. DATE OF BIRTH

3. SOCIAL SECURITY NUMBER

1. NAME OF APPLICANT

(Voluntary information)

4. SEX