Proposed Information Collection (Application for CHAMPVA Benefits); Comment Request, 9276-9277 [2010-4061]
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9276
Federal Register / Vol. 75, No. 39 / Monday, March 1, 2010 / Notices
and analyzed in connection with NMTC
evaluation efforts.
Current Actions: Extension of a
currently approved collection.
Type of review: Regular review.
Affected Public: Business or other forprofit institutions, not-for-profit
institutions, and State, local and Tribal
entities.
Estimated Number of Respondents:
495.
Estimated Annual Time per
Respondent: 12 hours.
Estimated Total Annual Burden
Hours: 5,940 hours.
Requests for Comments: Comments
submitted in response to this notice will
be summarized and/or included in the
request for OMB approval. All
comments will become a matter of
public record. The specific section of
the allocation agreement for which
comments are sought is the reporting
requirement that allocatees provide
notice to the CDFI Fund, through the
CDFI Fund’s allocation tracking system,
of the receipt of a Qualified Equity
Investment. Comments are invited on:
(a) Whether the collection of
information is necessary for the proper
performance of the functions of the
agency, including whether the
information shall have practical utility;
(b) the accuracy of the agency’s estimate
of the burden of the collection of
information; (c) ways to enhance the
quality, utility, and clarity of the
information to be collected; (d) ways to
minimize the burden of the collection of
information on respondents, including
through the use of technology; and (e)
estimates of capital or start-up costs and
costs of operation, maintenance, and
purchase of services required to provide
information.
Authority: 12 U.S.C. 4701 et seq.; 26 U.S.C.
45D.
Dated: February 19, 2010.
Jeffrey C. Berg,
Legal Counsel, Community Development
Financial Institutions Fund.
[FR Doc. 2010–3900 Filed 2–26–10; 8:45 am]
BILLING CODE 4810–70–M
DEPARTMENT OF THE TREASURY
Office of Thrift Supervision
mstockstill on DSKH9S0YB1PROD with NOTICES
[AC–35: OTS No. H–4649]
Harvard Illinois Bancorp, Inc., Harvard,
Illinois; Approval of Conversion
Application
Notice is hereby given that on
February 12, 2010, the Office of Thrift
Supervision approved the application of
Harvard Savings Bank, Harvard, Illinois,
VerDate Nov<24>2008
16:46 Feb 26, 2010
Jkt 220001
to convert to the stock form of
organization. Copies of the application
are available for inspection by
appointment (phone number: 202–906–
5922 or e-mail Public.Info@
OTS.Treaas.gov) at the Public Reading
Room, 1700 G Street, NW., Washington,
DC 20552, and the OTS Central Regional
Office, 1 South Wacker Drive, Suite
2000, Chicago, Illinois 60606.
Dated: February 19, 2010.
By the Office of Thrift Supervision.
Sandra E. Evans,
Federal Register Liaison.
[FR Doc. 2010–3897 Filed 2–26–10; 8:45 am]
BILLING CODE 6720–01–M
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0219]
Proposed Information Collection
(Application for CHAMPVA Benefits);
Comment Request
AGENCY: Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
SUMMARY: The Veterans Health
Administration (VHA), Department of
Veterans Affairs (VA), 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 for information
needed to determine eligibility of
persons applying for healthcare benefits
under Civilian Health and Medical
Program—VA and to request
preauthorization of certain health care
services and benefits for children of
Vietnam veterans born with spina bifida
and certain other covered birth defects.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before April 30, 2010.
ADDRESSES: Submit written comments
on the collection of information through
the Federal Docket Management System
(FDMS) at https://www.Regulations.gov;
or to Mary Stout, Veterans Health
Administration (193E1), Department of
Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420 or e-mail:
mary.stout@va.gov. Please refer to ‘‘OMB
PO 00000
Frm 00128
Fmt 4703
Sfmt 4703
Control No. 2900–0219’’ in any
correspondence. During the comment
period, comments may be viewed online
through FDMS.
FOR FURTHER INFORMATION CONTACT:
Mary Stout at (202) 461–5867 or FAX
(202) 273–9381.
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, 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. Application for CHAMPVA
Benefits, VA Form 10–10d.
b. CHAMPVA Claim Form, VA Form
10–7959a.
c. CHAMPVA Other Health Insurance
(OHI) Certification, VA Form 10–7959c.
d. CHAMPVA Potential Liability
Claim, VA Form 10–7959d.
e. Claim for Miscellaneous Expenses,
VA Form 10–7959e
OMB Control Number: 2900–0219.
Type of Review: Extension of a
currently approved collection.
Abstracts:
a. VA Form 10–10d is used to
determine eligibility of persons
applying for healthcare benefits under
the CHAMPVA program.
b. VA Form 10–7959a is used to
accurately adjudicate and process
beneficiaries claims for payment/
reimbursement of related healthcare
expenses.
c. VA Form 10–7959c is used to
systematically obtain other health
insurance information and to correctly
coordinate benefits among all liable
parties.
d. VA Form 10–7959d is used to
gather additional information relative to
the injury or illness as well as third
party claim information.
e. Beneficiaries complete VA Form
10–7959e to claim payment/
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Federal Register / Vol. 75, No. 39 / Monday, March 1, 2010 / Notices
reimbursement of expenses related to
spina bifida and certain covered birth
defects.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. VA Form 10–10d—4,411 hours.
b. VA Form 10–7959a—37,336 hours.
c. VA Form 10–7959c—13,456 hours.
d. VA Form 10–7959d—467 hours.
e. VA Form 10–7959e—725 hours
Estimated Average Burden per
Respondent:
a. VA Form 10–10d—10 minutes.
b. VA Form 10–7959a—10 minutes.
c. VA Form 10–7959c—10 minutes.
d. VA Form 10–7959d—7 minutes.
e. VA Form 10–7959e—10 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VA Form 10–10d—26,468.
b. VA Form 10–7959a—224,018.
c. VA Form 10–7959c—80,733.
d. VA Form 10–7959d—4,000.
e. VA Form 10–7959e—4,400.
Dated: February 23, 2010.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010–4061 Filed 2–26–10; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0712]
Proposed Information Collection
(Nation-Wide Customer Satisfaction
Surveys) Activity: Comment Request
mstockstill on DSKH9S0YB1PROD with NOTICES
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 extension
of a previously approved collection, and
allow 60 days for public comment in
response to the notice. This notice
solicits comments on information
needed to identify problems or
complaints in VA’s health care services.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before April 30, 2010.
ADDRESSES: Submit written comments
on the collection of information through
VerDate Nov<24>2008
16:46 Feb 26, 2010
Jkt 220001
the Federal Docket Management System
(FDMS) at https://www.Regulations.gov;
or to Mary Stout, Veterans Health
Administration (193E1), Department of
Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420 or e-mail:
mary.stout@va.gov. Please refer to ‘‘OMB
Control No. 2900–0712’’ in any
correspondence. During the comment
period, comments may be viewed online
through FDMS.
FOR FURTHER INFORMATION CONTACT:
Mary Stout (202) 461–5867 or FAX (202)
273–9381.
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.
Title: Nation-wide Customer
Satisfaction Surveys, VA Forms 1465–2
through 1465–4.
OMB Control Number: 2900–0712.
Type of Review: Extension of a
previously approved collection.
Abstract: The Survey of Health
Experience of Patients (SHEP) Survey is
used to obtain information from VA
patients that will be used to identify
problems or compliant and to improve
the quality of health care services
delivered to veterans. Data will be use
to measure improvement toward the
goal of matching or exceeding non-VA
external benchmark performance.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. Inpatient Short Form, VA Form 10–
1465–2—16,875 hours.
b. Ambulatory Care Long Form, VA
Form 10–1465–3—9,802 hours.
c. Ambulatory Care Short Form, VA
Form 10–1465–4—67,573 hours.
Estimated Average Burden per
Respondent:
a. Inpatient Short Form, VA Form 10–
1465–2—15 minutes.
PO 00000
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9277
b. Ambulatory Care Long Form, VA
Form 10–1465–3—25 minutes.
c. Ambulatory Care Short Form, VA
Form 10–1465–4—20 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Inpatient Short Form, VA Form 10–
1465–2—75,000.
b. Ambulatory Care Long Form, VA
Form 10–1465–3—23,524.
c. Ambulatory Care Short Form, VA
Form 10–1465–4—202,720.
Dated: February 23, 2010.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010–4062 Filed 2–26–10; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–New (VA Form
0924)]
Proposed Information Collection (VA
National Rehabilitation Special Events,
Event Registration Applications);
Comment Request
AGENCY: Office of National Programs
and Special Events, Department of
Veterans Affairs.
ACTION: Notice.
SUMMARY: The Office of National
Programs and Special Events (NPSE),
Department of Veterans Affairs (VA), 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 collection in
use without an OMB control number,
and allow 60 days for public comment
in response to the notice. This notice
solicits comments for information
needed to participant in VA national
rehabilitation special events.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before April 30, 2010.
ADDRESSES: Submit written comments
on the collection of information through
the Federal Docket Management System
(FDMS) at https://www.Regulations.gov;
or to Matt Bristol, Office of National
Programs and Special Events (002C),
Department of Veterans Affairs, 810
Vermont Avenue, NW., Washington, DC
20420 or e-mail: matt.bristol@va.gov.
Please refer to ‘‘OMB Control No. 2900–
New (VA Form 0924)’’ in any
E:\FR\FM\01MRN1.SGM
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]]>Agencies
[Federal Register Volume 75, Number 39 (Monday, March 1, 2010)]
[Notices]
[Pages 9276-9277]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-4061]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0219]
Proposed Information Collection (Application for CHAMPVA
Benefits); Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Veterans Health Administration (VHA), Department of
Veterans Affairs (VA), 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 for
information needed to determine eligibility of persons applying for
healthcare benefits under Civilian Health and Medical Program--VA and
to request preauthorization of certain health care services and
benefits for children of Vietnam veterans born with spina bifida and
certain other covered birth defects.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before April 30, 2010.
ADDRESSES: Submit written comments on the collection of information
through the Federal Docket Management System (FDMS) at https://www.Regulations.gov; or to Mary Stout, Veterans Health Administration
(193E1), Department of Veterans Affairs, 810 Vermont Avenue, NW.,
Washington, DC 20420 or e-mail: mary.stout@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: Mary Stout at (202) 461-5867 or FAX
(202) 273-9381.
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, 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. Application for CHAMPVA Benefits, VA Form 10-10d.
b. CHAMPVA Claim Form, VA Form 10-7959a.
c. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-
7959c.
d. CHAMPVA Potential Liability Claim, VA Form 10-7959d.
e. Claim for Miscellaneous Expenses, VA Form 10-7959e
OMB Control Number: 2900-0219.
Type of Review: Extension of a currently approved collection.
Abstracts:
a. VA Form 10-10d is used to determine eligibility of persons
applying for healthcare benefits under the CHAMPVA program.
b. VA Form 10-7959a is used to accurately adjudicate and process
beneficiaries claims for payment/reimbursement of related healthcare
expenses.
c. VA Form 10-7959c is used to systematically obtain other health
insurance information and to correctly coordinate benefits among all
liable parties.
d. VA Form 10-7959d is used to gather additional information
relative to the injury or illness as well as third party claim
information.
e. Beneficiaries complete VA Form 10-7959e to claim payment/
[[Page 9277]]
reimbursement of expenses related to spina bifida and certain covered
birth defects.
Affected Public: Individuals or households.
Estimated Annual Burden:
a. VA Form 10-10d--4,411 hours.
b. VA Form 10-7959a--37,336 hours.
c. VA Form 10-7959c--13,456 hours.
d. VA Form 10-7959d--467 hours.
e. VA Form 10-7959e--725 hours
Estimated Average Burden per Respondent:
a. VA Form 10-10d--10 minutes.
b. VA Form 10-7959a--10 minutes.
c. VA Form 10-7959c--10 minutes.
d. VA Form 10-7959d--7 minutes.
e. VA Form 10-7959e--10 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VA Form 10-10d--26,468.
b. VA Form 10-7959a--224,018.
c. VA Form 10-7959c--80,733.
d. VA Form 10-7959d--4,000.
e. VA Form 10-7959e--4,400.
Dated: February 23, 2010.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010-4061 Filed 2-26-10; 8:45 am]
BILLING CODE 8320-01-P
