Proposed Information Collection Activity: Proposed Collection; Comment Request, 27319-27320 [E6-7057]

Download as PDF rmajette on PROD1PC67 with NOTICES Federal Register / Vol. 71, No. 90 / Wednesday, May 10, 2006 / Notices 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 June 9, 2006. FOR FURTHER INFORMATION CONTACT: Denise McLamb, Records Management Service (005E3), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 565–8374, FAX (202) 565–6950 or e-mail denise.mclamb@mail.va.gov. Please refer to ‘‘OMB Control No. 2900–0321.’’ Send comments and recommendations concerning any aspect of the information collection to VA’s OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503, (202) 395–7316. Please refer to ‘‘OMB Control No. 2900– 0321’’ in any correspondence. SUPPLEMENTARY INFORMATION: Title: Appointment of Veterans Service Organization as Claimant’s Representative, VA Form 21–22 and Appointment of Individual as Claimant’s Representative, VA Form 21– 22a. OMB Control Number: 2900–0321. Type of Review: Extension of a currently approved collection. Abstract: Claimants complete VA Forms 21–22 and 21–22a to appoint a veterans service organization or an individual to assist in the preparation, representation, and prosecution of claims for VA benefits and to authorize VA to disclose any or all records to the appointed representative. 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 on December 28, 2005 at pages 76914– 76915. Affected Public: Individuals or households. Estimated Annual Burden: 27,616 hours. a. VA Form 21–22—27,083 hours. b. VA Form 21–22a—533 hours. Estimated Average Burden Per Respondent: a. VA Form 21–22—5 minutes. b. VA Form 21–22a—5 minutes. Frequency of Response: One-time. Estimated Number of Respondents: 331,400. a. VA Form 21–22—325,000. VerDate Aug<31>2005 14:59 May 09, 2006 Jkt 208001 b. VA Form 251–22a—6,400. Dated: April 26, 2006. By direction of the Secretary. Denise McLamb, Program Analyst, Records Management Service. [FR Doc. E6–7056 Filed 5–9–06; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0160] Proposed Information Collection Activity: Proposed Collection; Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: 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 extension 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 determine whether State homes providing nursing home care and adult day health care are providing high quality care to eligible veterans. DATES: Written comments and recommendations on the proposed collection of information should be received on or before July 10, 2006. ADDRESSES: Submit written comments on the collection of information to Ann Bickoff, Veterans Health Administration (193E1), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-mail ann.bickoff@mail.va.gov. Please refer to ‘‘OMB Control No. 2900–0160’’ in any correspondence. FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273–8310. Under the PRA of 1995 (Public Law 104–13; 44 U.S.C. 3501—3521), 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, VHA invites SUPPLEMENTARY INFORMATION: PO 00000 Frm 00101 Fmt 4703 Sfmt 4703 27319 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. Titles a. Title 38, CFR Parts 51 and 52, State Home Programs. b. State Home Inspection Staffing Profile, VA Form 10–3567. c. State Home Report and Statement of Federal Aid Claimed, VA Form 10– 5588. d. State Home Program Application for Veteran Care—Medical Certification, VA Form 10–10SH. e. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals, VA Form 10– 0143. f. Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, VA Form 10–0143a. g. Certification Regarding Lobbying, VA Form 10–0144. h. Statement of Assurance of Compliance with Equal Opportunity Laws, VA Form 10–0144a. OMB Control Number: 2900–0160. Type of Review: Extension of a currently approved collection. Abstract: VA pays per diem to State homes providing nursing home and adult day health care services to eligible veterans. To ensure high quality care is furnished to the veterans, VA requires those facilities providing adult day health care to furnish an application for recognition based on certification; appeal information, application and justification for payment; records and reports which facility management must maintain regarding activities of residents or participants; information relating to whether the facility meets standards concerning residents’ rights and responsibilities prior to admission or enrollment, during admission or enrollment, and upon discharge; the records and reports which facilities management and health care professionals must maintain regarding residents or participants and employees; documents pertain to the management of the facilities; food menu planning; E:\FR\FM\10MYN1.SGM 10MYN1 27320 Federal Register / Vol. 71, No. 90 / Wednesday, May 10, 2006 / Notices pharmaceutical records; and life safety documentation. This information is necessary to ensure that VA per diem payments are limited to facilities providing high quality care to eligible veterans. Affected Public: State, Local or Tribal Government, Individuals or households, and Not for profit institutions. Estimated Total Annual Burden: 15,535 hours. a. Title 38, CFR Parts 51 and 52, State Home Programs—3,738 hours. b. State Home Inspection Staffing Profile, VA Form 10–3567—90 hours. c. State Home Report and Statement of Federal Aid Claimed, VA Form 10–5588—1,080 hours. d. State Home Program Application for Veteran Care—Medical Certification, VA Form 10–10SH— 10,566 hours. e. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals, VA Form 10–0143—15 hours. f. Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, VA Form 10–1043a—15 hours. g. Certification Regarding Lobbying, VA Form 10–0144—15 hours. h. Statement of Assurance of Compliance with Equal Opportunity Laws, VA Form 10– 0144a—15 hours. rmajette on PROD1PC67 with NOTICES Estimated Average Burden Per Respondent a. Title 38, CFR Parts 51 and 52, State Home Programs—7 minutes. b. State Home Inspection Staffing Profile, VA Form 10–3567—30 VerDate Aug<31>2005 14:59 May 09, 2006 Jkt 208001 minutes. c. State Home Report and Statement of Federal Aid Claimed, VA Form 10–5588—30 minutes. d. State Home Program Application for Veteran Care—Medical Certification, VA Form 10–10SH— 30 minutes. e. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals, VA Form 10–0143—5 minutes. f. Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, VA Form 10–1043a—5 minutes. g. Certification Regarding Lobbying, VA Form 10–0144—5 minutes. h. Statement of Assurance of Compliance with Equal Opportunity Laws, VA Form 10– 0144a—5 minutes. Frequency of Response: One-time. Estimated Number of Respondents a. Title 38, CFR Parts 51 and 52, State Home Programs—22,926. b. State Home Inspection Staffing Profile, VA Form 10–3567—180. c. State Home Report and Statement of Federal Aid Claimed, VA Form 10–5588—180. d. State Home Program Application for Veteran Care—Medical Certification, VA Form 10–10SH— 21,132. e. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals, VA Form 10–0143—180. f. Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, VA PO 00000 Frm 00102 Fmt 4703 Sfmt 4703 Form 10–1043a—180. g. Certification Regarding Lobbying, VA Form 10–0144—180. h. Statement of Assurance of Compliance with Equal Opportunity Laws, VA Form 10– 0144a—180. Estimated Total Annual Responses a. Title 38, CFR Parts 51 and 52, State Home Programs—23,466. b. State Home Inspection Staffing Profile, VA Form 10–3567—180. c. State Home Report and State of Federal Aid Claimed, VA Form 10– 5588—2,160. d. State Home Program Application for Veteran Care—Medical Certification, VA Form 10–10SH— 21,132. e. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals, VA Form 10–0143—180. f. Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, VA Form 10–1043a—180. g. Certification Regarding Lobbying, VA Form 10–0144—180. h. Statement of Assurance of Compliance with Equal Opportunity Laws, VA Form 10– 0144a—180. Dated: May 2, 2006. By direction of the Secretary. Denise McLamb, Program Analyst, Records Management Service. [FR Doc. E6–7057 Filed 5–9–06; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\10MYN1.SGM 10MYN1

Agencies

[Federal Register Volume 71, Number 90 (Wednesday, May 10, 2006)]
[Notices]
[Pages 27319-27320]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-7057]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0160]


Proposed Information Collection Activity: Proposed Collection; 
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 extension 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 determine whether State 
homes providing nursing home care and adult day health care are 
providing high quality care to eligible veterans.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 10, 2006.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (193E1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail ann.bickoff@mail.va.gov. Please refer to ``OMB Control No. 2900-
0160'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Public Law 104-13; 44 
U.S.C. 3501--3521), 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, 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.

Titles

    a. Title 38, CFR Parts 51 and 52, State Home Programs.
    b. State Home Inspection Staffing Profile, VA Form 10-3567.
    c. State Home Report and Statement of Federal Aid Claimed, VA Form 
10-5588.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-0143a.
    g. Certification Regarding Lobbying, VA Form 10-0144.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a.
    OMB Control Number: 2900-0160.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA pays per diem to State homes providing nursing home 
and adult day health care services to eligible veterans. To ensure high 
quality care is furnished to the veterans, VA requires those facilities 
providing adult day health care to furnish an application for 
recognition based on certification; appeal information, application and 
justification for payment; records and reports which facility 
management must maintain regarding activities of residents or 
participants; information relating to whether the facility meets 
standards concerning residents' rights and responsibilities prior to 
admission or enrollment, during admission or enrollment, and upon 
discharge; the records and reports which facilities management and 
health care professionals must maintain regarding residents or 
participants and employees; documents pertain to the management of the 
facilities; food menu planning;

[[Page 27320]]

pharmaceutical records; and life safety documentation. This information 
is necessary to ensure that VA per diem payments are limited to 
facilities providing high quality care to eligible veterans.
    Affected Public: State, Local or Tribal Government, Individuals or 
households, and Not for profit institutions.
    Estimated Total Annual Burden: 15,535 hours.
    a. Title 38, CFR Parts 51 and 52, State Home Programs--3,738 hours.
    b. State Home Inspection Staffing Profile, VA Form 10-3567--90 
hours.
    c. State Home Report and Statement of Federal Aid Claimed, VA Form 
10-5588--1,080 hours.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH--10,566 hours.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--15 hours.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043a--15 hours.
    g. Certification Regarding Lobbying, VA Form 10-0144--15 hours.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a--15 hours.

Estimated Average Burden Per Respondent

    a. Title 38, CFR Parts 51 and 52, State Home Programs--7 minutes.
    b. State Home Inspection Staffing Profile, VA Form 10-3567--30 
minutes.
    c. State Home Report and Statement of Federal Aid Claimed, VA Form 
10-5588--30 minutes.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH--30 minutes.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--5 minutes.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043a--5 minutes.
    g. Certification Regarding Lobbying, VA Form 10-0144--5 minutes.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a--5 minutes.
    Frequency of Response: One-time.

Estimated Number of Respondents

    a. Title 38, CFR Parts 51 and 52, State Home Programs--22,926.
    b. State Home Inspection Staffing Profile, VA Form 10-3567--180.
    c. State Home Report and Statement of Federal Aid Claimed, VA Form 
10-5588--180.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH--21,132.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--180.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043a--180.
    g. Certification Regarding Lobbying, VA Form 10-0144--180.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a--180.

Estimated Total Annual Responses

    a. Title 38, CFR Parts 51 and 52, State Home Programs--23,466.
    b. State Home Inspection Staffing Profile, VA Form 10-3567--180.
    c. State Home Report and State of Federal Aid Claimed, VA Form 10-
5588--2,160.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH--21,132.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--180.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043a--180.
    g. Certification Regarding Lobbying, VA Form 10-0144--180.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a--180.

    Dated: May 2, 2006.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Records Management Service.
[FR Doc. E6-7057 Filed 5-9-06; 8:45 am]
BILLING CODE 8320-01-P
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