Agency Information Collection (Payment and Reimbursement for Emergency Services for Non Service-Connected Conditions in Non-VA Facilities) Activity Under OMB Review, 78739 [2011-32268]

Download as PDF Federal Register / Vol. 76, No. 243 / Monday, December 19, 2011 / Notices DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0620] Agency Information Collection (Payment and Reimbursement for Emergency Services for Non Service– Connected Conditions in Non-VA Facilities) Activity Under OMB Review Veterans Health Administration, Department of Veterans Affairs. 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, 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 January 18, 2012. 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– 0620’’ 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) 632– 7479, Fax (202) 273–0487 or email denise.mclamb@va.gov. Please refer to ‘‘OMB Control No. 2900–0620.’’ SUPPLEMENTARY INFORMATION: Title: Payment and Reimbursement for Emergency Services for Non ServiceConnected Conditions in Non-VA Facilities, 38 U.S.C. 1725. OMB Control Number: 2900–0620. Type of Review: Extension of a currently approved collection. Abstract: Veterans enrolled in VA’s health-care system are personally liable for emergency treatment rendered at non-VA health facilities. Veterans or their representative, and the health care provider of the emergency treatment furnished to the veteran must submit a claim in writing or complete a Health Insurance Claim Form CMS 1500 or Medical Uniform Institutional Provider Bill Form UB–04 to request payment or reimbursement for such treatment. VA uses the data collected to determine the emcdonald on DSK5VPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 19:31 Dec 16, 2011 Jkt 226001 claimant’s eligibility for payment or reimbursement. 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 October 12, 2011, at page 63353. Affected Public: Business or other for– profit. Estimated Total Annual Burden: 51,768 hours. Estimated Average Burden per Respondent: 15 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 207,071. By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2011–32268 Filed 12–16–11; 8:45 am] BILLING CODE;P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0630] Agency Information Collection (Regulation on Application for Fisher Houses and Other Temporary Lodging and VHA Fisher House Application) Activity Under OMB Review Veterans Health Administration, Department of Veterans Affairs. 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, 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 January 18, 2012. 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– 0630’’ in any correspondence. FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records SUMMARY: PO 00000 Frm 00130 Fmt 4703 Sfmt 9990 78739 Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 632– 7479, FAX (202) 273–0487 or email denise.mclamb@va.gov. Please refer to ‘‘OMB Control No. 2900–0630.’’ SUPPLEMENTARY INFORMATION: Title: Regulation on Application for Fisher Houses and Other Temporary Lodging and VHA Fisher House Application, VA Forms 10–0408 and 10–0408a. OMB Control Number: 2900–0630. Type of Review: Extension of a currently approved collection. Abstract: VA provides temporary lodging to veterans receiving VA medical care or Compensation and Pension examinations and to family members or other persons accompanying the veteran. Application for temporary lodging may be by letter, telephone, email, facsimile or in person at the VA healthcare facility of jurisdiction. VA Forms 10–0408 and 10– 0408a can be used to collect data during the application process to determine the claimant’s eligibility for temporary lodging. Temporary lodging services are provided on a first come, first served basis. 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 October 12, 2011, at pages 63355–63356. Affected Public: Business or other forprofit. Estimated Total Annual Burden: 83,333 hours. Estimated Average Burden per Respondent: 10 minutes. Frequency of Response: Semiannually. Estimated Number of Respondents: 250,000. Estimated Total Annual Responses: 500,000. By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2011–32267 Filed 12–16–11; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\19DEN1.SGM 19DEN1

Agencies

[Federal Register Volume 76, Number 243 (Monday, December 19, 2011)]
[Notices]
[Page 78739]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-32268]



[[Page 78739]]

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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0620]


Agency Information Collection (Payment and Reimbursement for 
Emergency Services for Non Service-Connected Conditions in Non-VA 
Facilities) Activity Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-21), this notice announces that the Veterans Health 
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; it includes the actual data collection instrument.

DATES: Comments must be submitted on or before January 18, 2012.

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. 2900-0620'' 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) 632-7479, Fax (202) 273-0487 or email 
denise.mclamb@va.gov. Please refer to ``OMB Control No. 2900-0620.''

SUPPLEMENTARY INFORMATION:
    Title: Payment and Reimbursement for Emergency Services for Non 
Service-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725.
    OMB Control Number: 2900-0620.
    Type of Review: Extension of a currently approved collection.
    Abstract: Veterans enrolled in VA's health-care system are 
personally liable for emergency treatment rendered at non-VA health 
facilities. Veterans or their representative, and the health care 
provider of the emergency treatment furnished to the veteran must 
submit a claim in writing or complete a Health Insurance Claim Form CMS 
1500 or Medical Uniform Institutional Provider Bill Form UB-04 to 
request payment or reimbursement for such treatment. VA uses the data 
collected to determine the claimant's eligibility for payment or 
reimbursement.
    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 October 12, 2011, at page 63353.
    Affected Public: Business or other for-profit.
    Estimated Total Annual Burden: 51,768 hours.
    Estimated Average Burden per Respondent: 15 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 207,071.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-32268 Filed 12-16-11; 8:45 am]
BILLING CODE;P
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