Proposed Information Collection (Civilian Health And Medical Program of the Department of Veterans Affairs (CHAMPVA) Benefits-Application, Claim, Other Health Insurance & Potential Liability); Activity: Comment Request, 21667-21669 [2016-08348]

Download as PDF asabaliauskas on DSK3SPTVN1PROD with NOTICES Federal Register / Vol. 81, No. 70 / Tuesday, April 12, 2016 / Notices arrival, visitors will be required to present valid government-issued photo identification and to submit to security screening in order to inspect and photocopy comments. All comments received, including attachments and other supporting materials, are part of the public record and subject to public disclosure. Do not include any information in your comment or supporting materials that you consider confidential or inappropriate for public disclosure. FOR FURTHER INFORMATION CONTACT: Shaquita Merritt, OCC Clearance Officer, (202) 649–5490 or, for persons who are deaf or hard of hearing, TTY, (202) 649–5597, Legislative and Regulatory Activities Division, Office of the Comptroller of the Currency, 400 7th Street SW., Suite 3E–218, Mail Stop 9W–11, Washington, DC 20219. SUPPLEMENTARY INFORMATION: Under the PRA (44 U.S.C. 3501–3520), Federal agencies must obtain approval from the OMB for each collection of information they conduct or sponsor. ‘‘Collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) to include agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires Federal agencies to provide a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, the OCC is publishing notice of the proposed collection of information set forth in this document. The OCC is proposing to extend, with revision, the approval of the following information collection: Title: Notice Regarding Unauthorized Access to Customer Information. OMB Control No.: 1557–0227. Description: Section 501(b) of the Gramm-Leach-Bliley Act (15 U.S.C. 6801) requires the OCC to establish appropriate standards for national banks relating to administrative, technical, and physical safeguards: (1) To insure the security and confidentiality of customer records and information; (2) to protect against any anticipated threats or hazards to the security or integrity of such records; and (3) to protect against unauthorized access to, or use of, such records or information that could result in substantial harm or inconvenience to any customer. The Interagency Guidelines Establishing Information Security VerDate Sep<11>2014 17:18 Apr 11, 2016 Jkt 238001 Standards, 12 CFR part 30, Appendix B and part 170, Appendix B (collectively, Security Guidelines), which implement section 501(b), require each entity supervised by the OCC (supervised institution) to consider and adopt a response program, as appropriate, that specifies actions to be taken when the supervised institution suspects or detects that unauthorized individuals have gained access to customer information. The Interagency Guidance on Response Programs for Unauthorized Customer Information and Customer Notice (Breach Notice Guidance 1), which interprets the Security Guidelines, states that, at a minimum, a supervised institution’s response program should contain procedures for the following: (1) Assessing the nature and scope of an incident, and identifying what customer information systems and types of customer information have been accessed or misused; (2) Notifying its primary Federal regulator as soon as possible when the supervised institution becomes aware of an incident involving unauthorized access to, or use of, sensitive customer information; (3) Consistent with the OCC’s Suspicious Activity Report regulations, notifying appropriate law enforcement authorities and filing a timely SAR in situations in which a Federal criminal violation requires immediate attention, such as when a reportable violation is ongoing; (4) Taking appropriate steps to contain and control the incident in an effort to prevent further unauthorized access to, or use of, customer information, for example, by monitoring, freezing, or closing affected accounts, while preserving records and other evidence; and (5) Notifying customers as warranted. This collection of information covers the notice provisions in the Breach Notice Guidance. Type of Review: Regular. Affected Public: Businesses or other for-profit. Estimated Number of Respondents: 20. Total Estimated Annual Burden: 720 hours. Frequency of Response: On occasion. Comments submitted in response to this notice will be summarized and included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on: (a) Whether the collection of information is necessary for the proper 1 12 PO 00000 CFR part 30, Appendix B, Supplement A. Frm 00135 Fmt 4703 Sfmt 4703 21667 performance of the functions of the OCC, including whether the information has practical utility; (b) The accuracy of the OCC’s estimate of the burden of the information collection; (c) Ways to enhance the quality, utility, and clarity of the information to be collected; (d) Ways to minimize the burden of the collection on respondents, including through the use of automated collection techniques or other forms of information technology; and (e) Estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. Dated: April 6, 2016. Mary Hoyle Gottlieb, Regulatory Specialist, Legislative and Regulatory Activities Division. [FR Doc. 2016–08321 Filed 4–11–16; 8:45 am] BILLING CODE 4810–33–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0219] Proposed Information Collection (Civilian Health And Medical Program of the Department of Veterans Affairs (CHAMPVA) Benefits—Application, Claim, Other Health Insurance & Potential Liability); Activity: Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: The Veterans Health Administration (VHA) is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed revision of a currently approved collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on information needed to identify areas for improvement in clinical training programs. SUMMARY: Written comments and recommendations on the proposed collection of information should be received on or before June 13, 2016. ADDRESSES: Submit written comments on the collection of information through the Federal Docket Management System DATES: E:\FR\FM\12APN1.SGM 12APN1 asabaliauskas on DSK3SPTVN1PROD with NOTICES 21668 Federal Register / Vol. 81, No. 70 / Tuesday, April 12, 2016 / Notices (FDMS) at www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and Administrative Affairs, Veterans Health Administration (10B4), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email: Brian.McCarthy4@ va.gov. Please refer to ‘‘OMB Control No. 2900–0219’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461–6345. SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104–13; 44 U.S.C. 3501–3521), Federal agencies must obtain approval from OMB for each collection of information they conduct or sponsor. This request for comment is being made pursuant to section 3506(c)(2)(A) of the PRA. With respect to the following collection of information, VHA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VHA’s functions, including whether the information will have practical utility; (2) the accuracy of VHA’s estimate of the burden of the proposed collection of information; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or the use of other forms of information technology. For RIN 2900–AP09, the Notice of Proposed Rule Making (NPRM) package was not submitted to OMB for review at the time of publication of the NPRM. Titles: 1. VA Form 10–10d, Application for CHAMPVA Benefits 2. VA Form 10–7959a, CHAMPVA Claim Form 3. VA Form 10–7959c, CHAMPVA Other Health Insurance (OHI) Certification 4. VA Form 10–7959d, CHAMPVA Potential Liability Claim 5. VA Form 10–7959e, VA Claim for Miscellaneous Expenses 6. Payment (beneficially claims) 7. Review and Appeal Process OMB Control Number: 2900–0219. Type of Review: Revision of a currently approved collection. Abstracts 1. VA Form 10–10d, Application for CHAMPVA Benefits, is used to determine eligibility of persons applying for healthcare benefits under the CHAMPVA program in accordance with 38 U.S.C. 501 and 1781. VerDate Sep<11>2014 17:18 Apr 11, 2016 Jkt 238001 2. VA Form 10–7959a, CHAMPVA Claim Form, is used to adjudicate claims for CHAMPVA benefits in accordance with 38 U.S.C. 501 and 1781, and 10 U.S.C. 1079 and 1086. This information is required for accurate adjudication and processing of beneficiary submitted claims. The claim form is also instrumental in the detection and prosecution of fraud. In addition, the claim form is the only mechanism to obtain, on an interim basis, other health insurance (OHI) information. 3. Except for Medicaid and health insurance policies that are purchased exclusively for the purpose of supplementing CHAMPVA benefits, CHAMPVA is always the secondary payer of healthcare benefits (38 U.S.C. 501 and 1781, and 10 U.S.C. 1086). VA Form 10–7959c, CHAMPVA—Other Health Insurance (OHI) Certification, is used to systematically obtain OHI information and to correctly coordinate benefits among all liable parties. 4. The Federal Medical Care Recovery Act (42 U.S.C. 2651–2653), mandates recovery of costs associated with healthcare services related to an injury/ illness caused by a third party. VA Form 10–7959d, CHAMPVA Potential Liability Claim, provides basic information from which potential liability can be assessed. Additional authority includes 38 U.S.C. 501; 38 CFR 1.900 et seq.; 10 U.S.C. 1079 and 1086; 42 U.S.C. 2651–2653; and Executive Order 9397. 5. VA Form 10–7959e, VA Claim for Miscellaneous Expenses, information collection is needed to carry out the health care programs for certain children of Korea and/or Vietnam veterans authorized under 38 U.S.C., chapter 18, as amended by section 401, P.L. 106–419 and section 102, P.L. 108– 183. VA’s medical regulations 38 CFR part 17 (17.900 through 17.905) establish regulations regarding provision of health care for certain children of Korea and Vietnam veterans and women Vietnam veterans’ children born with spina bifida and certain other covered birth defects. These regulations also specify the information to be included in requests for preauthorization and claims from approved health care providers. 6. Payment of Claims for Provision of Health Care for Certain Children of Korea and/or Vietnam Veterans (includes provider billing and VA Forms 10–7959e). This data collection is for the purpose of claiming payment/ reimbursement of expenses related to spina bifida and certain covered birth defects. Beneficiaries utilize VA Form 10–7959e, VA Claim for Miscellaneous PO 00000 Frm 00136 Fmt 4703 Sfmt 4703 Expenses. Providers utilize provider generated billing statements and standard billing forms such as: Uniform Billing-Forms UB–04, and CMS 1500, Medicare Health Insurance Claims Form. VA would be unable to determine the correct amount to reimburse providers for their services or beneficiaries for covered expenses without the requested information. The information is instrumental in the timely and accurate processing of provider and beneficiary claims for reimbursement. The frequency of submissions is not determined by VA, but will determined by the provider or claimant and will be based on the volume of medical services and supplies provided to patients and claims for reimbursement are submitted individually or in batches. 7. Review and Appeal Process Regarding Provision of Health Care or Payment Relating to Provision of Health Care for Certain Children of Korea and/ or Vietnam Veterans. The provisions of 38 CFR 17.904 establish a review process regarding disagreements by an eligible veteran’s child or representative with a determination concerning provision of health care or a health care provider’s disagreement with a determination regarding payment. The person or entity requesting reconsideration of such determination is required to submit such a request to the Chief Business Office Purchased Care (CBOPC) (Attention: Chief, Customer Service), in writing within one year of the date of initial determination. The request must state why the decision is in error and include any new and relevant information not previously considered. After reviewing the matter, a Customer Service Advisor issues a written determination to the person or entity seeking reconsideration. If such person or entity remains dissatisfied with the determination, the person or entity is permitted to submit within 90 days of the date of the decision a written request for review by the Director, CBOPC. Affected Public: Individuals or households. Estimated Annual Burden 1. VA Form 10–10d—4,411 hours. 2. VA Form 10–7959a—37,336 hours. 3. VA Form 10–7959c—13,456 hours. 4. VA Form 10–7959d—467 hours. 5. VA Form 10–7959e—200 hours. 6. Payment (beneficially claims)—500 hours. 7. Review and Appeal Process—200 hours. E:\FR\FM\12APN1.SGM 12APN1 Federal Register / Vol. 81, No. 70 / Tuesday, April 12, 2016 / Notices Estimated Average Burden Per Respondent asabaliauskas on DSK3SPTVN1PROD with NOTICES 1. VA Form 10–10d—10 minutes. 2. VA Form 10–7959a—10 minutes. 3. VA Form 10–7959c—10 minutes. 4. VA Form 10–7959d—7 minutes. 5. VA Form 10–7959e—15 minutes. 6. Payment (beneficially claims)—10 minutes. VerDate Sep<11>2014 17:18 Apr 11, 2016 Jkt 238001 21669 7. Review and Appeal Process—20 minutes. Frequency of Response: Annually. 6. Payment (beneficially claims)— 3,000. 7. Review and Appeal Process—600. Estimated Annual Responses By direction of the Secretary. Kathleen M. Manwell, Program Analyst, VA Privacy Service, Office of Privacy and Records Management, Department of Veterans Affairs. PO 00000 1. VA Form 10–10d—26,468. 2. VA Form 10–7959a—224,018. 3. VA Form 10–7959c—80,733. 4. VA Form 10–7959d—4,000. 5. VA Form 10–7959e—800. Frm 00137 Fmt 4703 Sfmt 9990 [FR Doc. 2016–08348 Filed 4–11–16; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\12APN1.SGM 12APN1

Agencies

[Federal Register Volume 81, Number 70 (Tuesday, April 12, 2016)]
[Notices]
[Pages 21667-21669]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-08348]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0219]


Proposed Information Collection (Civilian Health And Medical 
Program of the Department of Veterans Affairs (CHAMPVA) Benefits--
Application, Claim, Other Health Insurance & Potential Liability); 
Activity: Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Veterans Health Administration (VHA) is announcing an 
opportunity for public comment on the proposed collection of certain 
information by the agency. Under the Paperwork Reduction Act (PRA) of 
1995, Federal agencies are required to publish notice in the Federal 
Register concerning each proposed collection of information, including 
each proposed revision of a currently approved collection, and allow 60 
days for public comment in response to the notice. This notice solicits 
comments on information needed to identify areas for improvement in 
clinical training programs.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before June 13, 2016.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System

[[Page 21668]]

(FDMS) at www.Regulations.gov; or to Brian McCarthy, Office of 
Regulatory and Administrative Affairs, Veterans Health Administration 
(10B4), Department of Veterans Affairs, 810 Vermont Avenue NW., 
Washington, DC 20420 or email: Brian.McCarthy4@va.gov. Please refer to 
``OMB Control No. 2900-0219'' in any correspondence. During the comment 
period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461-6345.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), Federal agencies must obtain approval from OMB for 
each collection of information they conduct or sponsor. This request 
for comment is being made pursuant to section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VHA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    For RIN 2900-AP09, the Notice of Proposed Rule Making (NPRM) 
package was not submitted to OMB for review at the time of publication 
of the NPRM.
    Titles:

1. VA Form 10-10d, Application for CHAMPVA Benefits
2. VA Form 10-7959a, CHAMPVA Claim Form
3. VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification
4. VA Form 10-7959d, CHAMPVA Potential Liability Claim
5. VA Form 10-7959e, VA Claim for Miscellaneous Expenses
6. Payment (beneficially claims)
7. Review and Appeal Process

    OMB Control Number: 2900-0219.
    Type of Review: Revision of a currently approved collection.

Abstracts

    1. VA Form 10-10d, Application for CHAMPVA Benefits, is used to 
determine eligibility of persons applying for healthcare benefits under 
the CHAMPVA program in accordance with 38 U.S.C. 501 and 1781.
    2. VA Form 10-7959a, CHAMPVA Claim Form, is used to adjudicate 
claims for CHAMPVA benefits in accordance with 38 U.S.C. 501 and 1781, 
and 10 U.S.C. 1079 and 1086. This information is required for accurate 
adjudication and processing of beneficiary submitted claims. The claim 
form is also instrumental in the detection and prosecution of fraud. In 
addition, the claim form is the only mechanism to obtain, on an interim 
basis, other health insurance (OHI) information.
    3. Except for Medicaid and health insurance policies that are 
purchased exclusively for the purpose of supplementing CHAMPVA 
benefits, CHAMPVA is always the secondary payer of healthcare benefits 
(38 U.S.C. 501 and 1781, and 10 U.S.C. 1086). VA Form 10-7959c, 
CHAMPVA--Other Health Insurance (OHI) Certification, is used to 
systematically obtain OHI information and to correctly coordinate 
benefits among all liable parties.
    4. The Federal Medical Care Recovery Act (42 U.S.C. 2651-2653), 
mandates recovery of costs associated with healthcare services related 
to an injury/illness caused by a third party. VA Form 10-7959d, CHAMPVA 
Potential Liability Claim, provides basic information from which 
potential liability can be assessed. Additional authority includes 38 
U.S.C. 501; 38 CFR 1.900 et seq.; 10 U.S.C. 1079 and 1086; 42 U.S.C. 
2651-2653; and Executive Order 9397.
    5. VA Form 10-7959e, VA Claim for Miscellaneous Expenses, 
information collection is needed to carry out the health care programs 
for certain children of Korea and/or Vietnam veterans authorized under 
38 U.S.C., chapter 18, as amended by section 401, P.L. 106-419 and 
section 102, P.L. 108-183. VA's medical regulations 38 CFR part 17 
(17.900 through 17.905) establish regulations regarding provision of 
health care for certain children of Korea and Vietnam veterans and 
women Vietnam veterans' children born with spina bifida and certain 
other covered birth defects. These regulations also specify the 
information to be included in requests for preauthorization and claims 
from approved health care providers.
    6. Payment of Claims for Provision of Health Care for Certain 
Children of Korea and/or Vietnam Veterans (includes provider billing 
and VA Forms 10-7959e). This data collection is for the purpose of 
claiming payment/reimbursement of expenses related to spina bifida and 
certain covered birth defects. Beneficiaries utilize VA Form 10-7959e, 
VA Claim for Miscellaneous Expenses. Providers utilize provider 
generated billing statements and standard billing forms such as: 
Uniform Billing-Forms UB-04, and CMS 1500, Medicare Health Insurance 
Claims Form. VA would be unable to determine the correct amount to 
reimburse providers for their services or beneficiaries for covered 
expenses without the requested information. The information is 
instrumental in the timely and accurate processing of provider and 
beneficiary claims for reimbursement. The frequency of submissions is 
not determined by VA, but will determined by the provider or claimant 
and will be based on the volume of medical services and supplies 
provided to patients and claims for reimbursement are submitted 
individually or in batches.
    7. Review and Appeal Process Regarding Provision of Health Care or 
Payment Relating to Provision of Health Care for Certain Children of 
Korea and/or Vietnam Veterans. The provisions of 38 CFR 17.904 
establish a review process regarding disagreements by an eligible 
veteran's child or representative with a determination concerning 
provision of health care or a health care provider's disagreement with 
a determination regarding payment. The person or entity requesting 
reconsideration of such determination is required to submit such a 
request to the Chief Business Office Purchased Care (CBOPC) (Attention: 
Chief, Customer Service), in writing within one year of the date of 
initial determination. The request must state why the decision is in 
error and include any new and relevant information not previously 
considered. After reviewing the matter, a Customer Service Advisor 
issues a written determination to the person or entity seeking 
reconsideration. If such person or entity remains dissatisfied with the 
determination, the person or entity is permitted to submit within 90 
days of the date of the decision a written request for review by the 
Director, CBOPC.
    Affected Public: Individuals or households.

Estimated Annual Burden

    1. VA Form 10-10d--4,411 hours.
    2. VA Form 10-7959a--37,336 hours.
    3. VA Form 10-7959c--13,456 hours.
    4. VA Form 10-7959d--467 hours.
    5. VA Form 10-7959e--200 hours.
    6. Payment (beneficially claims)--500 hours.
    7. Review and Appeal Process--200 hours.

[[Page 21669]]

Estimated Average Burden Per Respondent

    1. VA Form 10-10d--10 minutes.
    2. VA Form 10-7959a--10 minutes.
    3. VA Form 10-7959c--10 minutes.
    4. VA Form 10-7959d--7 minutes.
    5. VA Form 10-7959e--15 minutes.
    6. Payment (beneficially claims)--10 minutes.
    7. Review and Appeal Process--20 minutes.
    Frequency of Response: Annually.

Estimated Annual Responses

    1. VA Form 10-10d--26,468.
    2. VA Form 10-7959a--224,018.
    3. VA Form 10-7959c--80,733.
    4. VA Form 10-7959d--4,000.
    5. VA Form 10-7959e--800.
    6. Payment (beneficially claims)--3,000.
    7. Review and Appeal Process--600.

    By direction of the Secretary.
 Kathleen M. Manwell,
 Program Analyst, VA Privacy Service, Office of Privacy and Records 
Management, Department of Veterans Affairs.
[FR Doc. 2016-08348 Filed 4-11-16; 8:45 am]
 BILLING CODE 8320-01-P
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