VA Form 26-0967: Debarment Certification Guide (2025)

VA Form 26-0967: Debarment Certification Guide (2025) – VA Form 26-0967 is an official U.S. Department of Veterans Affairs (VA) certification form required for certain federal grant applicants. It confirms that the applicant (or participant) and its principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from federal transactions.

The current version is February 2025 (supersedes the February 2022 edition). It carries OMB Control Number 2900-0903 (expires February 29, 2028) with an estimated public burden of 1 hour per response.

Download VA Form 26-0967: https://www.vba.va.gov/pubs/forms/VBA-26-0967-ARE.pdf

What Is VA Form 26-0967?

This form is a Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion. It is a standard requirement under federal nonprocurement debarment and suspension regulations (Executive Order 12549 and 2 CFR Part 180) as implemented for VA programs.

The form contains:

  • Project description and location/FAI number fields
  • Certification statements
  • Company/organization information
  • Signature of an authorized representative

By signing, the participant makes a material representation that it is eligible to receive federal funds and participate in covered transactions.

Purpose of VA Form 26-0967

The primary purpose is to protect federal funds by ensuring only eligible participants receive VA grants. Specifically, this form is required by regulations implementing 38 U.S.C. 2108 for the Specially Adapted Housing Assistive Technology (SAHAT) Grant Program.

According to 38 CFR § 36.4412, applicants must submit VA Form 26-0967 to confirm they have not been debarred or suspended and remain eligible to participate in the VA grant process and receive federal funds.

Who Must Submit VA Form 26-0967?

You (or your organization) must submit this form if you are applying as a technology grant applicant for the SAHAT Grant Program. This includes:

  • Individuals
  • Researchers
  • For-profit entities
  • Non-profit organizations
  • Other persons or entities developing new assistive technologies for specially adapted housing for eligible Veterans and service members

The certification applies to the applicant and its principals.

When Is VA Form 26-0967 Required?

This form is required as part of a complete application package for the Specially Adapted Housing Assistive Technology Grant Program whenever VA publishes a Notice of Funding Availability (NoFA) or Notice of Funds Opportunity on Grants.gov.

Applications typically include:

  • Standard Form 424 (Application for Federal Assistance)
  • VA Form 26-0967
  • Responses addressing the published scoring criteria
  • Any additional information requested in the NoFA

How to Complete VA Form 26-0967? (Step-by-Step)

  1. Download the current form (February 2025 version).
  2. Project Description — Provide a brief description of the proposed assistive technology project.
  3. Project Location / FAI Number — Enter the project location and any Federal Award Identifier (if applicable).
  4. Certification Statements — Read and understand both statements. By signing, you certify that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from federal participation.
  5. If you cannot certify — Attach a written explanation to the proposal.
  6. Company Information — Enter the legal name of the company/organization and its Tax Identification Number (TIN).
  7. Authorized Representative — Provide the name, title, signature, and date signed by the person authorized to bind the applicant.

Important: The certification is a material representation. Knowingly submitting a false certification can result in severe penalties, including suspension or debarment from federal programs.

Key Instructions for Certification (Summary)

The form includes detailed instructions (numbered 1–9). Key points include:

  • The certification is relied upon when entering the transaction.
  • You must provide immediate written notice if the certification becomes erroneous due to changed circumstances.
  • You agree not to enter transactions with debarred or excluded persons unless authorized.
  • You must flow down the certification clause (without modification) to all lower-tier covered transactions and solicitations.
  • You may rely on certifications from lower-tier participants unless you know they are erroneous.
  • You are expected to act as a prudent person in ordinary business dealings.

Full instructions appear on page 2 of the official form.

Penalties for False or Erroneous Certification

Willful submission of false information carries severe penalties under federal law. If a participant knowingly enters a covered transaction with a debarred or suspended person (except as authorized), the originating agency may pursue remedies including suspension and/or debarment. Erroneous certifications discovered later can also trigger these actions in addition to other available remedies.

Where to Download VA Form 26?-0967

Official Download (Recommended):

Official VA Form Page:

Always use the latest February 2025 version. Older versions (e.g., February 2022) are no longer accepted.

How and Where to Submit VA Form 26-0967?

Submit the completed form as part of your full SAHAT grant application package through www.Grants.gov in response to the current Notice of Funding Availability (NoFA). Do not mail the form separately to the VA Reports Clearance Officer.

Monitor Grants.gov and VA announcements for open funding opportunities under the Specially Adapted Housing Assistive Technology Grant Program.

  • Specially Adapted Housing (SAH) Grant — For eligible Veterans/service members with certain severe disabilities (use VA Form 26-4555).
  • Special Housing Adaptation (SHA) Grant — For less severe disabilities.
  • Temporary Residence Adaptation (TRA) Grant — One-time grant to adapt a family member’s home.
  • VA Form 26-0967a — Sometimes referenced alongside this form for SAHAT criteria and responses.

Learn more about VA disability housing grants:

Tips for Successful Submission

  • Use the exact current form revision (February 2025).
  • Ensure the authorized representative signs and dates the form.
  • If you have any uncertainty about eligibility, attach a clear explanation rather than risking a false certification.
  • Keep copies of all submitted materials.
  • Review the full NoFA carefully for any additional requirements or updates.
  • Consult legal or compliance counsel if your organization has complex ownership or prior federal interactions.

Frequently Asked Questions

Is VA Form 26-0967 only for SAHAT grants?
Yes, the current form specifically references regulations implementing 38 U.S.C. 2108 for the Specially Adapted Housing Assistive Technology Grant Program.

What if my organization was previously debarred but the period has ended?
You may be able to certify if the debarment period has expired and you are no longer excluded. Provide supporting documentation if requested.

Can individuals apply for SAHAT grants?
Yes. Both individuals and entities are eligible to apply as technology grant applicants.

Where can I check debarment status?
The System for Award Management (SAM.gov) maintains the official list of excluded parties. Participants are expected to exercise due diligence consistent with prudent business practices.

Additional Trusted Resources

  • VA Form 26-0967 Official Page —
  • 38 CFR § 36.4412 – Specially Adapted Housing Assistive Technology Grant Program —
  • Grants.gov (search for current SAHAT opportunities)
  • VA Loan Guaranty Service – Specially Adapted Housing information
  • System for Award Management (SAM.gov) – Exclusions

This guide is based on official VA sources, the current form, and governing regulations as of 2025–2026. Requirements can change with new Notices of Funding Availability, so always verify the latest NoFA on Grants.gov before applying.