Agency Information Collection Activity: Request for and Consent to Release of Information From Claimant's Records, 16088-16089 [2017-06350]
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Federal Register / Vol. 82, No. 61 / Friday, March 31, 2017 / Notices
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of
Privacy and Records Management,
Department of Veterans Affairs.
[FR Doc. 2017–06348 Filed 3–30–17; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0802]
Agency Information Collection Activity
Under OMB Review: Shoulder and Arm
Conditions Disability Benefits
Questionnaire
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
Veterans Benefits Administration,
Department of Veterans Affairs, will
submit the collection of information
abstracted below to the Office of
Management and Budget (OMB) for
review and comment. The PRA
submission describes the nature of the
information collection and its expected
cost and burden and it includes the
actual data collection instrument.
DATES: Comments must be submitted on
or before May 1, 2017.
ADDRESSES: Submit written comments
on the collection of information through
www.Regulations.gov, or to Office of
Information and Regulatory Affairs,
Office of Management and Budget, Attn:
VA Desk Officer; 725 17th St. NW.,
Washington, DC 20503 or sent through
electronic mail to oira_submission@
omb.eop.gov. Please refer to ‘‘OMB
Control No. 2900–0802’’ in any
correspondence.
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor, Enterprise
Records Service (005R1B), Department
of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420,
(202) 461–5870 or email cynthia.harveypryor@va.gov. Please refer to ‘‘OMB
Control No. 2900–0802’’ in any
correspondence.
SUPPLEMENTARY INFORMATION:
sradovich on DSK3GMQ082PROD with NOTICES
SUMMARY:
Authority: 44 U.S.C. 3501–21.
Title: Shoulder and Arm Conditions
Disability Benefits Questionnaire (VA
Form 21–0960M–12).
OMB Control Number: 2900–0802.
Type of Review: Extension of a
currently approved collection.
Abstract: VA Forms 21–0960M–12 is
used to gather necessary information
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16:31 Mar 30, 2017
Jkt 241001
from a claimant’s treating physician
regarding the results of medical
examinations.
An agency may not conduct or
sponsor, and a person is not required to
respond to a collection of information
unless it displays a currently valid OMB
control number.
The Federal Register Notice with a
60-day comment period soliciting
comments on this collection of
information was published at Volume
82 FR 8568, Thursday, January 26, 2017.
Affected Public: Individuals or
Households.
Estimated Annual Burden: 25,000.
Estimated Average Burden per
Respondent: 30 minutes.
Frequency of Response: One time.
Estimated Number of Respondents:
50,000.
By direction of the Secretary:
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of
Privacy and Records Management,
Department of Veterans Affairs.
[FR Doc. 2017–06349 Filed 3–30–17; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0028]
Agency Information Collection
Activity: Request for and Consent to
Release of Information From
Claimant’s Records
Office of Information and
Technology, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
The Office of Information and
Technology (IT), Department of
Veterans Affairs (VA), is announcing an
opportunity for public comment on the
proposed collection of certain
information used 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 this notice.
This notice solicits comments for
information needed from service
organizations requesting to be placed on
VA’s mailing lists for specific
publications; to request additional
information from the correspondent to
identify a veteran; to request for and
consent to release of information from
claimant’s records to a third party; and
to determine an applicant’s eligibility to
SUMMARY:
PO 00000
Frm 00070
Fmt 4703
Sfmt 4703
receive a list of names and addresses of
Veterans and their dependents.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before May 30, 2017.
ADDRESSES: Submit written comments
on the collection of information through
Federal Docket Management System
(FDMS) at www.Regulations.gov or to
Martin L. Hill, Office of Information and
Technology (005R1B), Department of
Veterans Affairs, 810 Vermont Avenue
NW., Washington, DC 20420 or email:
martin.hill@va.gov. Please refer to
‘‘2900–0028’’ in any correspondence.
During the comment period, comments
may be viewed online through the
FDMS.
FOR FURTHER INFORMATION CONTACT:
Martin L. Hill at (202) 632–7452.
SUPPLEMENTARY INFORMATION: Under the
PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
3501–21), Federal agencies must obtain
approval from the Office of Management
and Budget (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, IT invites
comments on: (1) Whether the proposed
collection of information is necessary
for the proper performance of IT’s
functions, including whether the
information will have practical utility;
(2) the accuracy of IT’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.
Titles:
a. Application of Service
Representative for Placement on Mailing
List, VA Form 3215.
b. Request for and Consent to Release
of Information from Claimant’s Records,
VA Form 3288.
c. Request to Correspondent for
Identifying Information, VA Form Letter
70–2.
d. 38 CFR 1.519(A) Lists of Names
and Addresses.
OMB Control Number: 2900–0028.
Type of Review: Extension without
change of a currently approved
collection.
Abstract:
a. VA operates an outreach services
program to ensure Veterans and
beneficiaries have information about
E:\FR\FM\31MRN1.SGM
31MRN1
Federal Register / Vol. 82, No. 61 / Friday, March 31, 2017 / Notices
sradovich on DSK3GMQ082PROD with NOTICES
benefits and services to which they may
be entitled. To support the program, VA
distributes copies of publications to
Veterans Service Organizations’
representatives to be used in rendering
services and representation of veterans,
their spouses and dependents. Service
organizations complete VA Form 3215
to request placement on a mailing list
for specific VA publications.
b. Veterans or beneficiaries complete
VA Form 3288 to provide VA with a
written consent to release his or her
records or information to third parties
such as insurance companies,
physicians and other individuals.
c. VA Form Letter 70–2 is used to
obtain additional information from a
correspondent when the incoming
correspondence does not provide
sufficient information to identify a
Veteran. VA personnel use the
information to identify the Veteran,
determine the location of a specific file,
and to accomplish the action requested
by the correspondent such as processing
a benefit claim or file material in the
individual’s claims folder.
d. Title 38 U.S.C. 5701(f)(1)
authorized the disclosure of names or
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16:31 Mar 30, 2017
Jkt 241001
addresses, or both of present or former
members of the Armed Forces and/or
their beneficiaries to nonprofit
organizations (including members of
Congress) to notify Veterans of Title 38
benefits and to provide assistance to
Veterans in obtaining these benefits.
This release includes VA’s Outreach
Program for the purpose of advising
Veterans of non-VA Federal State and
local benefits and programs.
Affected Public: Individuals or
households, Not for profit institutions,
and State, local or tribal government.
Estimated Annual Burden:
a. Application of Service
Representative for Placement on Mailing
List, VA Form 3215—25 hours.
b. Request for and Consent to Release
of Information From Claimant’s
Records, VA Form 3288—18,875 hours.
c. Request to Correspondent for
Identifying Information, VA Form Letter
70–2—3,750 hours.
d. 38 CFR 1.519(A) Lists of Names
and Addresses—50 hours.
Estimated Average Burden Per
Respondent:
a. Application of Service
Representative for Placement on Mailing
List, VA Form 3215—10 minutes.
PO 00000
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Fmt 4703
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16089
b. Request for and Consent to Release
of Information From Claimant’s
Records, VA Form 3288—7.5 minutes.
c. Request to Correspondent for
Identifying Information, VA Form Letter
70–2—5 minutes.
d. 38 CFR 1.519(A) Lists of Names
and Addresses—60 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Application of Service
Representative for Placement on Mailing
List, VA Form 3215—150.
b. Request for and Consent to Release
of Information From Claimant’s
Records, VA Form 3288—151,000.
c. Request to Correspondent for
Identifying Information, VA Form Letter
70–2—45,000.
d. 38 CFR 1.519(A) Lists of Names
and Addresses—50.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of
Privacy and Records Management,
Department of Veterans Affairs.
[FR Doc. 2017–06350 Filed 3–30–17; 8:45 am]
BILLING CODE 8320–01–P
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31MRN1
]]>Agencies
[Federal Register Volume 82, Number 61 (Friday, March 31, 2017)]
[Notices]
[Pages 16088-16089]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-06350]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0028]
Agency Information Collection Activity: Request for and Consent
to Release of Information From Claimant's Records
AGENCY: Office of Information and Technology, Department of Veterans
Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Office of Information and Technology (IT), Department of
Veterans Affairs (VA), is announcing an opportunity for public comment
on the proposed collection of certain information used 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 this notice. This notice solicits comments for
information needed from service organizations requesting to be placed
on VA's mailing lists for specific publications; to request additional
information from the correspondent to identify a veteran; to request
for and consent to release of information from claimant's records to a
third party; and to determine an applicant's eligibility to receive a
list of names and addresses of Veterans and their dependents.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before May 30, 2017.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at www.Regulations.gov
or to Martin L. Hill, Office of Information and Technology (005R1B),
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC
20420 or email: martin.hill@va.gov. Please refer to ``2900-0028'' in
any correspondence. During the comment period, comments may be viewed
online through the FDMS.
FOR FURTHER INFORMATION CONTACT: Martin L. Hill at (202) 632-7452.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C. 3501-21), Federal agencies must obtain approval from the Office
of Management and Budget (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, IT invites
comments on: (1) Whether the proposed collection of information is
necessary for the proper performance of IT's functions, including
whether the information will have practical utility; (2) the accuracy
of IT'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.
Titles:
a. Application of Service Representative for Placement on Mailing
List, VA Form 3215.
b. Request for and Consent to Release of Information from
Claimant's Records, VA Form 3288.
c. Request to Correspondent for Identifying Information, VA Form
Letter 70-2.
d. 38 CFR 1.519(A) Lists of Names and Addresses.
OMB Control Number: 2900-0028.
Type of Review: Extension without change of a currently approved
collection.
Abstract:
a. VA operates an outreach services program to ensure Veterans and
beneficiaries have information about
[[Page 16089]]
benefits and services to which they may be entitled. To support the
program, VA distributes copies of publications to Veterans Service
Organizations' representatives to be used in rendering services and
representation of veterans, their spouses and dependents. Service
organizations complete VA Form 3215 to request placement on a mailing
list for specific VA publications.
b. Veterans or beneficiaries complete VA Form 3288 to provide VA
with a written consent to release his or her records or information to
third parties such as insurance companies, physicians and other
individuals.
c. VA Form Letter 70-2 is used to obtain additional information
from a correspondent when the incoming correspondence does not provide
sufficient information to identify a Veteran. VA personnel use the
information to identify the Veteran, determine the location of a
specific file, and to accomplish the action requested by the
correspondent such as processing a benefit claim or file material in
the individual's claims folder.
d. Title 38 U.S.C. 5701(f)(1) authorized the disclosure of names or
addresses, or both of present or former members of the Armed Forces
and/or their beneficiaries to nonprofit organizations (including
members of Congress) to notify Veterans of Title 38 benefits and to
provide assistance to Veterans in obtaining these benefits. This
release includes VA's Outreach Program for the purpose of advising
Veterans of non-VA Federal State and local benefits and programs.
Affected Public: Individuals or households, Not for profit
institutions, and State, local or tribal government.
Estimated Annual Burden:
a. Application of Service Representative for Placement on Mailing
List, VA Form 3215--25 hours.
b. Request for and Consent to Release of Information From
Claimant's Records, VA Form 3288--18,875 hours.
c. Request to Correspondent for Identifying Information, VA Form
Letter 70-2--3,750 hours.
d. 38 CFR 1.519(A) Lists of Names and Addresses--50 hours.
Estimated Average Burden Per Respondent:
a. Application of Service Representative for Placement on Mailing
List, VA Form 3215--10 minutes.
b. Request for and Consent to Release of Information From
Claimant's Records, VA Form 3288--7.5 minutes.
c. Request to Correspondent for Identifying Information, VA Form
Letter 70-2--5 minutes.
d. 38 CFR 1.519(A) Lists of Names and Addresses--60 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Application of Service Representative for Placement on Mailing
List, VA Form 3215--150.
b. Request for and Consent to Release of Information From
Claimant's Records, VA Form 3288--151,000.
c. Request to Correspondent for Identifying Information, VA Form
Letter 70-2--45,000.
d. 38 CFR 1.519(A) Lists of Names and Addresses--50.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of Privacy and Records Management,
Department of Veterans Affairs.
[FR Doc. 2017-06350 Filed 3-30-17; 8:45 am]
BILLING CODE 8320-01-P
