Agency Information Collection (Disability Benefits Questionnaires-Group 3) Activity Under OMB Review, 35950-35951 [2011-15202]

Download as PDF 35950 Federal Register / Vol. 76, No. 118 / Monday, June 20, 2011 / Notices Title: Servicer’s Staff Appraisal Reviewer (SAR) Application, VA Form 26–0829. OMB Control Number: 2900–0715. Type of Review: Extension of a currently approved collection. Abstract: VA Form 26–0829 is completed by servicers to nominate employees for approval as Staff Appraisal Reviewer (SAR). Servicers SAR’s will have the authority to review real estate appraisals and to issue liquidation notices of value on behalf of VA. VA will also use the data collected to track the location of SARs when there is a change in employment. 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 April 13, 2011, at page 20822. Affected Public: Business or other forprofit. Estimated Annual Burden: 2 hours. Estimated Average Burden per Respondent: 5 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 20. By direction of the Secretary. Dated: June 15, 2011. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2011–15200 Filed 6–17–11; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0556] Agency Information Collection Activity (Living Will and Durable Power of Attorney for Health Care) Under OMB Review Department of Veterans Affairs, Veterans Health Administration. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501–21), this notice announces that the Veterans Health Administration (VHA), 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 includes the actual data collection instrument. sroberts on DSK5SPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 18:24 Jun 17, 2011 Jkt 223001 DATES: Comments must be submitted on or before July 20, 2011. DEPARTMENT OF VETERANS AFFAIRS Submit written comments on the collection of information through https://www.Regulations.gov; or 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– 0556’’ in any correspondence. [OMB Control No. 2900–New (DBQs—Group 3)] ADDRESSES: FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT: Denise McLamb, Enterprise Records Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 461–7485, Fax (202) 461–0966 or e-mail denise.mclamb@va.gov. Please refer to ‘‘OMB Control No. 2900–0556.’’ SUPPLEMENTARY INFORMATION Title: Living Will and Durable Power of Attorney for Health Care, VA Form 10–0137. OMB Control Number: 2900–0556. Type of Review: Extension of a currently approved collection. Abstract: Claimants admitted to a VA medical facility complete VA Form 10– 0137 to appoint a health care agent to make decision about his or her medical treat and to record specific instructions about their treatment preferences in the event they no longer can express their preferred treatment. VA’s health care professionals use the data to carry out the claimant’s wish. 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 April 13, 2011, at pages 20822–20823. Affected Public: Individuals or Households. Estimated Total Annual Burden: 171,811 hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One time. Estimated Number of Respondents: 343,622. Dated: June 15, 2011. By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2011–15201 Filed 6–17–11; 8:45 am] BILLING CODE 8320–01–P PO 00000 Frm 00119 Fmt 4703 Sfmt 4703 Agency Information Collection (Disability Benefits Questionnaires— Group 3) Activity Under OMB Review Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501–3521), this notice announces that the Veterans Benefits Administration (VBA), 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 July 20, 2011. ADDRESSES: Submit written comments on the collection of information through https://www.Regulations.gov or 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– New (DBQs—Group 3)’’ in any correspondence. SUMMARY: FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 461– 7485, FAX (202) 461–0966 or e-mail denise.mclamb@va.gov. Please refer to ‘‘OMB Control No. 2900—New (DBQs— Group 3).’’ SUPPLEMENTARY INFORMATION: Titles: a. Central Nervous System and Neuromusculo Diseases, Disability Benefits Questionnaire, VA Form 21– 0960C–5. b. Headaches (Including Migraine Headaches), Disability Benefits Questionnaire, VA Form 21–0960C–8. c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA Form 21– 0960C–9. d. Esophageal Disorders (Including GERD), Disability Benefits Questionnaire, VA Form 21–0960G–1. e. Gallbladder and Pancreas Conditions, Disability Benefits Questionnaire, VA Form 21–0960G–2. f. Intestinal Disorders (Other Than Surgical or Infectious) (Including E:\FR\FM\20JNN1.SGM 20JNN1 Federal Register / Vol. 76, No. 118 / Monday, June 20, 2011 / Notices sroberts on DSK5SPTVN1PROD with NOTICES Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis, and Diverticulitis) Disability Benefits Questionnaire, VA Form 21–0960G–3. g. Intestines Surgical and/or Infectious Intestinal Disorders (Bowel Resection, Colostomy, Ileostomy, Bacterial and Parasitic Infections) Disability Benefits Questionnaire, VA Form 21–0960G–4. h. Hepatitis, Cirrhosis and Other Liver Conditions, Disability Benefits Questionnaire, VA Form 21–0960G–5. i. Peritoneal Adhesions Disability Benefits Questionnaire, VA Form 21– 0960G–6. j. Stomach and Duodenal Conditions (Not Including GERD or Esophageal Disorders) Disability Benefits Questionnaire, VA Form 21–0960G–7. k. Rectum and Anus Disability Benefits Questionnaire, VA Form 21– 0960H–2. l. Breast Conditions and Disorders Disability Benefits Questionnaire, VA Form 21–0960K–1. m. Gynecological Conditions Disability Benefits Questionnaire, VA Form 21–0960K–2. n. Sleep Apnea Disability Benefits Questionnaire, VA Form 21–0960L–2. o. Arthritis Disability Benefits Questionnaire, VA Form 21–0960M–3. p. Osteomyelitis Disability Benefits Questionnaire, VA Form 21–0960M–11. q. Ear Conditions (Including Vestibular and Infectious) Disability Benefits Questionnaire, VA Form 21– 0960N–1. OMB Control Number: 2900–New (DBQs—Group 3). Type of Review: New collection. Abstract: Data collected on VA Form 21–0960 series will be used obtain VerDate Mar<15>2010 16:50 Jun 17, 2011 Jkt 223001 information from claimants treating physician that is necessary to adjudicate a claim for disability benefits. 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 April 15, 2011, at pages 21429–21430. Affected Public: Individuals or households. Estimated Annual Burden: a. VA Form 21–0960C–5—5,000. b. VA Form 21–0960C–8—3,750. c. VA Form 21–0960C–9—7,500. d. VA Form 21–0960G–1—10,000. e. VA Form 21–0960G–2—1,250. f. VA Form 21–0960G–3—1,250. g. VA Form 21–0960G–4—1,250. h. VA Form 21–0960G–5—5,000. i. VA Form 21–0960G–6—1,250. j. VA Form 21–0960G–7—2,500. k. VA Form 21–0960H–2—2,500. l. VA Form 21–0960K–1—7,500. m. VA Form 21–0960K–2—10,000. n. VA Form 21–0960L–2—1,250. o. VA Form 21–0960M–3—25,000. p. VA Form 21–0960M–11—10,000. q. VA Form 21–0960N–1—6,250. Estimated Average Burden per Respondent: a. VA Form 21–0960C–5—30 minutes. b. VA Form 21–0960C–8—15 minutes. c. VA Form 21–0960C–9—45 minutes. d. VA Form 21–0960G–1—15 minutes. e. VA Form 21–0960G–2—15 minutes. f. VA Form 21–0960G–3—15 minutes. g. VA Form 21–0960G–4—15 minutes. h. VA Form 21–0960G–5—30 minutes. PO 00000 Frm 00120 Fmt 4703 Sfmt 9990 35951 i. VA Form 21–0960G–6—15 minutes. j. VA Form 21–0960G–7—15 minutes. k. VA Form 21–0960H–2—15 minutes. l. VA Form 21–0960K–1—15 minutes. m. VA Form 21–0960K–2—30 minutes. n. VA Form 21–0960L–2—15 minutes. o. VA Form 21–0960M–3—15 minutes. p. VA Form 21–0960M–11—15 minutes. q. VA Form 21–0960N–1—15 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: a. VA Form 21–0960C–5—10,000. b. VA Form 21–0960C–8—15,000. c. VA Form 21–0960C–9—10,000. d. VA Form 21–0960G–1—40,000. e. VA Form 21–0960G–2—5,000. f. VA Form 21–0960G–3—5,000. g. VA Form 21–0960G–4—5,000. h. VA Form 21–0960G–5—10,000. i. VA Form 21–0960G–6—5,000. j. VA Form 21–0960G–7—10,000. k. VA Form 21–0960H–2—10,000. l. VA Form 21–0960K–1—30,000. m. VA Form 21–0960K–2—20,000. n. VA Form 21–0960L2—5,000. o. VA Form 21–0960M–3—100,000. p. VA Form 21–0960M–11—40,000. q. VA Form 21–0960N–1—25,000. By direction of the Secretary. Dated: June 15, 2011. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2011–15202 Filed 6–17–11; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\20JNN1.SGM 20JNN1

Agencies

[Federal Register Volume 76, Number 118 (Monday, June 20, 2011)]
[Notices]
[Pages 35950-35951]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-15202]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New (DBQs--Group 3)]


Agency Information Collection (Disability Benefits 
Questionnaires--Group 3) Activity Under OMB Review

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits 
Administration (VBA), 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 July 20, 2011.

ADDRESSES: Submit written comments on the collection of information 
through https://www.Regulations.gov or 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-New (DBQs--Group 3)'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Washington, DC 20420, (202) 461-7485, FAX (202) 461-0966 or e-mail 
denise.mclamb@va.gov. Please refer to ``OMB Control No. 2900--New 
(DBQs--Group 3).''

SUPPLEMENTARY INFORMATION: 
    Titles:
    a. Central Nervous System and Neuromusculo Diseases, Disability 
Benefits Questionnaire, VA Form 21-0960C-5.
    b. Headaches (Including Migraine Headaches), Disability Benefits 
Questionnaire, VA Form 21-0960C-8.
    c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA 
Form 21-0960C-9.
    d. Esophageal Disorders (Including GERD), Disability Benefits 
Questionnaire, VA Form 21-0960G-1.
    e. Gallbladder and Pancreas Conditions, Disability Benefits 
Questionnaire, VA Form 21-0960G-2.
    f. Intestinal Disorders (Other Than Surgical or Infectious) 
(Including

[[Page 35951]]

Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and 
Diverticulitis) Disability Benefits Questionnaire, VA Form 21-0960G-3.
    g. Intestines Surgical and/or Infectious Intestinal Disorders 
(Bowel Resection, Colostomy, Ileostomy, Bacterial and Parasitic 
Infections) Disability Benefits Questionnaire, VA Form 21-0960G-4.
    h. Hepatitis, Cirrhosis and Other Liver Conditions, Disability 
Benefits Questionnaire, VA Form 21-0960G-5.
    i. Peritoneal Adhesions Disability Benefits Questionnaire, VA Form 
21-0960G-6.
    j. Stomach and Duodenal Conditions (Not Including GERD or 
Esophageal Disorders) Disability Benefits Questionnaire, VA Form 21-
0960G-7.
    k. Rectum and Anus Disability Benefits Questionnaire, VA Form 21-
0960H-2.
    l. Breast Conditions and Disorders Disability Benefits 
Questionnaire, VA Form 21-0960K-1.
    m. Gynecological Conditions Disability Benefits Questionnaire, VA 
Form 21-0960K-2.
    n. Sleep Apnea Disability Benefits Questionnaire, VA Form 21-0960L-
2.
    o. Arthritis Disability Benefits Questionnaire, VA Form 21-0960M-3.
    p. Osteomyelitis Disability Benefits Questionnaire, VA Form 21-
0960M-11.
    q. Ear Conditions (Including Vestibular and Infectious) Disability 
Benefits Questionnaire, VA Form 21-0960N-1.
    OMB Control Number: 2900-New (DBQs--Group 3).
    Type of Review: New collection.
    Abstract: Data collected on VA Form 21-0960 series will be used 
obtain information from claimants treating physician that is necessary 
to adjudicate a claim for disability benefits.
    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 April 15, 2011, at pages 21429-21430.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 21-0960C-5--5,000.
    b. VA Form 21-0960C-8--3,750.
    c. VA Form 21-0960C-9--7,500.
    d. VA Form 21-0960G-1--10,000.
    e. VA Form 21-0960G-2--1,250.
    f. VA Form 21-0960G-3--1,250.
    g. VA Form 21-0960G-4--1,250.
    h. VA Form 21-0960G-5--5,000.
    i. VA Form 21-0960G-6--1,250.
    j. VA Form 21-0960G-7--2,500.
    k. VA Form 21-0960H-2--2,500.
    l. VA Form 21-0960K-1--7,500.
    m. VA Form 21-0960K-2--10,000.
    n. VA Form 21-0960L-2--1,250.
    o. VA Form 21-0960M-3--25,000.
    p. VA Form 21-0960M-11--10,000.
    q. VA Form 21-0960N-1--6,250.
    Estimated Average Burden per Respondent:
    a. VA Form 21-0960C-5--30 minutes.
    b. VA Form 21-0960C-8--15 minutes.
    c. VA Form 21-0960C-9--45 minutes.
    d. VA Form 21-0960G-1--15 minutes.
    e. VA Form 21-0960G-2--15 minutes.
    f. VA Form 21-0960G-3--15 minutes.
    g. VA Form 21-0960G-4--15 minutes.
    h. VA Form 21-0960G-5--30 minutes.
    i. VA Form 21-0960G-6--15 minutes.
    j. VA Form 21-0960G-7--15 minutes.
    k. VA Form 21-0960H-2--15 minutes.
    l. VA Form 21-0960K-1--15 minutes.
    m. VA Form 21-0960K-2--30 minutes.
    n. VA Form 21-0960L-2--15 minutes.
    o. VA Form 21-0960M-3--15 minutes.
    p. VA Form 21-0960M-11--15 minutes.
    q. VA Form 21-0960N-1--15 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. VA Form 21-0960C-5--10,000.
    b. VA Form 21-0960C-8--15,000.
    c. VA Form 21-0960C-9--10,000.
    d. VA Form 21-0960G-1--40,000.
    e. VA Form 21-0960G-2--5,000.
    f. VA Form 21-0960G-3--5,000.
    g. VA Form 21-0960G-4--5,000.
    h. VA Form 21-0960G-5--10,000.
    i. VA Form 21-0960G-6--5,000.
    j. VA Form 21-0960G-7--10,000.
    k. VA Form 21-0960H-2--10,000.
    l. VA Form 21-0960K-1--30,000.
    m. VA Form 21-0960K-2--20,000.
    n. VA Form 21-0960L2--5,000.
    o. VA Form 21-0960M-3--100,000.
    p. VA Form 21-0960M-11--40,000.
    q. VA Form 21-0960N-1--25,000.

    By direction of the Secretary.

    Dated: June 15, 2011.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-15202 Filed 6-17-11; 8:45 am]
BILLING CODE 8320-01-P
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