Agency Information Collection Activity Under OMB Review: Presidential Memorial Certificate Form, 16475-16476 [2017-06574]
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Federal Register / Vol. 82, No. 63 / Tuesday, April 4, 2017 / Notices
relating to the household income, attest
to out of pocket medical expenses, attest
to sale of primary home real estate and
attest to separation from spouse for the
income year under the Income
Verification Division’s review. The
Veteran’s signature is required on page
2 of HEC Form 200–1A. If the Veteran
has medical/health limitations that does
not enable the Veteran to physically
sign the form with a wet signature, the
Veteran must mark an ‘‘X’’ to designate
a signature; two witnesses must verify
the ‘‘X’’ as the Veteran’s signature. HEC,
IVD will use the completed HEC Form
200–1A to assist in verifying the
Veteran’s correct gross household
income to ensure the Veteran is placed
in the correct priority group for health
care.
The HEC, IVD uses HEC Form 220–1
(Spouse’s Income Verification
Response) to collect income verification
information, as applicable, from the
Veteran’s spouse by requesting the
spouse to verify the listed income on the
form as reported to IVD by IRS/SSA,
report any additional income not
reported by IRS/SSA and sign and date
the form. If the spouse has medical/
health limitations that does not enable
the spouse to physically sign the form
with a wet signature, the spouse must
mark an ‘‘X’’ to designate a signature;
two witnesses must verify the ‘‘X’’ as
the Veteran’s signature. HEC, IVD will
use the completed HEC Form 220–1 to
assist in verifying the Veteran’s correct
gross household income to ensure the
Veteran is placed in the correct priority
group for health care.
The HEC, IVD uses the HEC Form
340–1 (Declaration of Representative)
for the Veteran and the spouse (if
applicable) to appoint a representative,
authorizing HEC, IVD to release
information to a designated appointee
for a specific income year. Such
information includes confidential
federal tax information, other income,
and medical benefits eligibility related
information. The Veteran and spouse (if
applicable) must sign and date the form.
The HEC, IVD uses the HEC Income
Verification—Additional Information
Checklist to request from the Veteran
any additional information needed to
adjudicate the Income Verification case.
The Veteran providing the requested
information usually results in the best
interest to the Veteran.
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
VerDate Sep<11>2014
16:21 Apr 03, 2017
Jkt 241001
of information was published at 82 FRN
8566–8567 on January 26, 2017.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. Mailed with Veterans’ Initial Letters—
HEC Form 200–1A—89,001 hours
b. Mailed with Spouses’ Initial Letters—
HEC Form 220–1—28,530 hours
c. Mailed to Veterans When Necessary—
HEC Form 340–1—1,701 hours
d. Mailed to Veterans When
Necessary—Checklist—761 hours
Estimated Average Burden Per
Respondent:
a. Mailed with Veterans’ Initial Letters—
HEC Form 200–1A—30 minutes
b. Mailed with Spouses’ Initial Letters—
HEC Form 220–1—20 minutes
c. Mailed to Veterans When Necessary—
HEC Form 340–1—15 minutes
d. Mailed to Veterans When
Necessary—Checklist—761—15
minutes
Frequency of Response: Annually.
Estimated Annual Responses:
a. Mailed with Veterans’ Initial Letters—
HEC Form 200–1A—178,002
b. Mailed with Spouses’ Initial Letters—
HEC Form 220–1—85,590
c. Mailed to Veterans When Necessary—
HEC Form 340–1—6,805
d. Mailed to Veterans When
Necessary—Checklist—761—3,044
Authority: 44 U.S.C. 3501–3521
16475
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor, Enterprise
Records Service (005R1B), Department
of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420, at
202–461–5870.
CORRECTION
In FR Doc. FR Doc. 2017–04559,
published on Wednesday, March 8,
2017 at 82FR44, make the following
correction. On page 13056, in the third
column, in second paragraph section,
titled DATES, replace ‘‘DATES: Written
comments and recommendations on the
proposed collection of information
should be received on or before April 7,
2017,’’ to read as follows:
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before May 7, 2017.
Dated: March 29, 2017.
By direction of the Secretary:
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[FR Doc. 2017–06572 Filed 4–3–17; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[OMB Control No. 2900–0567]
[FR Doc. 2017–06573 Filed 4–3–17; 8:45 am]
AGENCY:
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0657]
Conflicting Interests Certification for
Proprietary Schools Comment Request
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice; correction.
AGENCY:
The Department of Veterans
Affairs (VA) published a collection of
information notice in a Federal Register
on Wednesday, March 8, 2017 that
contained an error. The intent was to
publish a 60-day Public Comment
notice.
However, the notice incorrectly stated
an insert date 30 days after date of
publication in the Federal Register in
the DATES section. This document
corrects the error by updating the public
comment date.
SUMMARY:
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Agency Information Collection Activity
Under OMB Review: Presidential
Memorial Certificate Form
National Cemetery
Administration, Department of Veterans
Affairs.
ACTION: Notice.
In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
National Cemetery Administration
(NCA), 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; it includes
the actual data collection instrument.
DATES: Comments must be submitted on
or before May 4, 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@
SUMMARY:
E:\FR\FM\04APN1.SGM
04APN1
16476
Federal Register / Vol. 82, No. 63 / Tuesday, April 4, 2017 / Notices
omb.eop.gov. Please refer to ‘‘OMB
Control No. 2900–0567’’ 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. 2900–0567’’ in any
correspondence.
SUPPLEMENTARY INFORMATION:
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Title: Presidential Memorial
Certificate Form VA Form 40–0247.
OMB Control Number: 2900–0567.
Type of Review: Revision of a
currently approved collection.
Abstract: The National Cemetery
Administration (NCA) made updates to
its current VA Form 40–0247. The
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16:21 Apr 03, 2017
Jkt 241001
original VA Form 40–0247 is for
requests for initial copies of a
Presidential Memorial Certificates
(PMC’s). The updates to the form would
include the following changes with no
additional respondent burden:
• Format changes
• SSN or Military Service Number from
discharge Documents
• Mailing address, email address,
telephone and fax number updates
• Wording changed to allow the public
to also use the form for first time
requests
Upon appropriate approval, the NCA
Web site will display the updated
version of the VA Form 40–0247 for
public use.
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
PO 00000
Frm 00143
Fmt 4703
Sfmt 9990
control number. The Federal Register
Notice with a 60-day comment period
soliciting comments on this collection
of information was published at 82 FRN
06728 on January 19, 2017.
Affected Public: 125,000.
Estimated Annual Burden: 6,250
hours.
Estimated Average Burden Per
Respondent: 3 minutes each.
Frequency of Response: One-time.
Estimated Number of Respondents:
125,000.
Authority: 44 U.S.C. 3501–3521.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[FR Doc. 2017–06574 Filed 4–3–17; 8:45 am]
BILLING CODE 8320–01–P
E:\FR\FM\04APN1.SGM
04APN1
Agencies
[Federal Register Volume 82, Number 63 (Tuesday, April 4, 2017)]
[Notices]
[Pages 16475-16476]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-06574]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0567]
Agency Information Collection Activity Under OMB Review:
Presidential Memorial Certificate Form
AGENCY: National Cemetery Administration, Department of Veterans
Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995,
this notice announces that the National Cemetery Administration (NCA),
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; it
includes the actual data collection instrument.
DATES: Comments must be submitted on or before May 4, 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@
[[Page 16476]]
omb.eop.gov. Please refer to ``OMB Control No. 2900-0567'' 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.harvey-pryor@va.gov. Please refer to ``OMB Control No. 2900-
0567'' in any correspondence.
SUPPLEMENTARY INFORMATION:
Title: Presidential Memorial Certificate Form VA Form 40-0247.
OMB Control Number: 2900-0567.
Type of Review: Revision of a currently approved collection.
Abstract: The National Cemetery Administration (NCA) made updates
to its current VA Form 40-0247. The original VA Form 40-0247 is for
requests for initial copies of a Presidential Memorial Certificates
(PMC's). The updates to the form would include the following changes
with no additional respondent burden:
Format changes
SSN or Military Service Number from discharge Documents
Mailing address, email address, telephone and fax number
updates
Wording changed to allow the public to also use the form for
first time requests
Upon appropriate approval, the NCA Web site will display the updated
version of the VA Form 40-0247 for public use.
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 82 FRN 06728 on January 19, 2017.
Affected Public: 125,000.
Estimated Annual Burden: 6,250 hours.
Estimated Average Burden Per Respondent: 3 minutes each.
Frequency of Response: One-time.
Estimated Number of Respondents: 125,000.
Authority: 44 U.S.C. 3501-3521.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-06574 Filed 4-3-17; 8:45 am]
BILLING CODE 8320-01-P