Proposed Information Collection (Homeless Providers Grant and Per Diem Program) Activity; Comment Request, 39342-39343 [2012-16102]
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39342
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institution against a fiduciary’s
accounting. The following forms will be
used to ensure claimants’ benefits
payments are administered properly.
a. VA Forms 21–4706, 4706b and
4706c are used by estate to determine
proper usage of benefits paid to
fiduciaries. The 21–4706 and 21–4706b
are both necessary to conform to
requirement of various state courts.
b. VA Form 21–4718 is provided to
VA fiduciaries to submit accountings to
either State courts or the VA. It is not
a reporting form per se, but a vehicle to
assist the fiduciary in accurately
maintaining records of monies received
and spent.
c. VA Form 21–4718a—Fiduciaries
are required to obtain certifications that
the balances remaining on deposit in
financial institutions as shown on
accountings are correct. Certifying
official at a financial institution
completing the form must affix the
institution’s official seal or stamp. The
data collected is used to appoint an
appropriate fiduciary for a VA
beneficiary and to prevent fiduciaries
from supplying false certification,
embezzling funds, and possibly prevent
and/or identify fraud, waste and abuse
of government funds paid to fiduciaries
on behalf of VA beneficiaries.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. Annual-Final Report and Account,
VA Form 21–4706—1,100.
b. Federal Fiduciary’s Account, VA
Form 21–4706b—6,300.
c. Court Appointed Fiduciary’s
Account, VA Form 21–4706c—2,000.
d. Account Book, VA Form 21–4718—
20,000.
e. Certificate of Balance on Deposit
and Authorization to Disclose Financial
Records, VA Form 21–4718a—166.
Estimated Average Burden per
Respondent:
a. Annual-Final Report and Account,
VA Form 21–4706—30 minutes.
b. Federal Fiduciary’s Accounts, VA
Form 21–4706b—27 minutes.
c. Court Appointed Fiduciary’s
Account, VA Form 21–4706c—30
minutes.
d. Account Book, VA Form 21–4718—
21⁄2 hours.
e. Certificate of Balance on Deposit
and Authorization to Disclose Financial
Records, VA Form 21–4718a—3
minutes.
Frequency of Response: Annually.
Estimated Number of Respondents:
a. Annual-Final Report and Account,
VA Form 21–4706—2,200.
b. Federal Fiduciary’s Accounts, VA
Form 21–4706b—14,000.
c. Court Appointed Fiduciary’s
Account, VA Form 21–4706c—4,000.
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Jkt 226001
d. Account Book, VA Form 21–4718—
8,000.
e. Certificate of Balance on Deposit
and Authorization to Disclose Financial
Records, VA Form 21–4718a—3,312.
Dated: June 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012–16101 Filed 6–29–12; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0554]
Proposed Information Collection
(Homeless Providers Grant and Per
Diem Program) Activity; Comment
Request
Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
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
revision of a currently approved
collection, and allow 60 days for public
comment in response to the notice. This
notice solicits comments on the
information needed to determine an
applicant’s eligibility to receive a grant
and/or per diem for programs to assist
homeless veterans’ transition to
independent living and to determine if
the grantee is meeting the objectives
outlined in the original grant
application.
SUMMARY:
Written comments and
recommendations on the proposed
collection of information should be
received on or before August 31, 2012.
ADDRESSES: Submit written comments
on the collection of information through
Federal Docket Management System
(FDMS) at www.Regulations.gov; or to
Cynthia Harvey-Pryor, Veterans Health
Administration (10P7BFP), Department
of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420; or
email: cynthia.harvey-pryor@va.gov.
Please refer to ‘‘OMB Control No. 2900–
0554’’ in any correspondence. During
the comment period, comments may be
viewed online through the FDMS.
DATES:
PO 00000
Frm 00135
Fmt 4703
Sfmt 4703
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor (202) 461–5870 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 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. Homeless Providers Grant and Per
Diem Program, Capital Grant.
Application, VA Form 10–0361–CG.
b. Homeless Providers Grant and Per
Diem Program, Life Safety Code
Application, VA Form 10–0361–LSC.
c. Homeless Providers Grant and Per
Diem Program, Per Diem Only
Application, VA Form 10–0361–PDO.
d. Homeless Providers Grant and Per
Diem Program, Special Needs
Application, VA Form 10–0361–SN.
e. Compliance Reports for Per Diem
and Special Needs Grants. No form
needed. May be reported to VA in
standard business narrative.
f. Homeless Providers Grant and Per
Diem Program, Technical Assistance
Application, VA Form 10–0361–TA.
g. Compliance Reports for Technical
Assistance Grants. No form needed. May
be reported to VA in standard business
narrative.
OMB Control Number: 2900–0554.
Type of Review: Revision of a
currently approved collection.
Abstract: VA Form 10–0361 series,
Homeless Providers Grant and Per Diem
Program, will be used to evaluate
applicants eligibility to receive a grant
and/or per diem payments, apply the
specific criteria to rate and rank each
application; and to obtain information
necessary to ensure that Federal funds
are awarded to applicants who are
financially stable and who will conduct
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02JYN1
mstockstill on DSK4VPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 127 / Monday, July 2, 2012 / Notices
the program for which grant and/or per
diem award was made.
Affected Public: Not-for-profit
institutions.
Estimated Annual Burden:
a. Homeless Providers Grant and Per
Diem Program, Capital Grant.
Application, VA Form 10–0361–CG—
3,500 hours.
b. Homeless Providers Grant and Per
Diem Program, Life Safety Code
Application, VA Form 10–0361–LSC—
2,000 hours.
c. Homeless Providers Grant and Per
Diem Program, Per Diem Only
Application, VA Form 10–0361–PDO—
3,000 hours.
d. Homeless Providers Grant and Per
Diem Program, Special Needs
Application, VA Form 10–0361–SN—
4,000 hours.
e. Compliance Reports for Per Diem
and Special Needs Grants—1,500 hours.
f. Homeless Providers Grant and Per
Diem Program, Technical Assistance
Application, VA Form 10–0361–TA—
250 hours.
g. Compliance Reports for Technical
Assistance Grants—90 hours.
Estimated Average Burden per
Respondent:
a. Homeless Providers Grant and Per
Diem Program, Capital Grant
Application, VA Form 10–0361–CG—35
hours.
b. Homeless Providers Grant and Per
Diem Program, Life Safety Code
Application, VA Form 10–0361–LSC—
10 hours.
c. Homeless Providers Grant and Per
Diem Program, Per Diem Only
Application, VA Form 10–0361–PDO—
20 hours.
d. Homeless Providers Grant and Per
Diem Program, Special Needs
Application, VA Form 10–0361–SN—20
hours.
e. Compliance Reports for Per Diem
and Special Needs Grants—5 hours.
f. Homeless Providers Grant and Per
Diem Program, Technical Assistance
Application, VA Form 10–0361–TA—10
hours.
g. Compliance Reports for Technical
Assistance Grants—2.25 hours.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Homeless Providers Grant and Per
Diem Program, Capital Grant
Application, VA Form 10–0361–CG—
100.
b. Homeless Providers Grant and Per
Diem Program, Life Safety Code
Application, VA Form 10–0361–LSC—
200.
c. Homeless Providers Grant and Per
Diem Program, Per Diem Only
Application, VA Form 10–0361–PDO—
150.
VerDate Mar<15>2010
17:22 Jun 29, 2012
Jkt 226001
d. Homeless Providers Grant and Per
Diem Program, Special Needs
Application, VA Form 10–0361–SN—
200.
e. Compliance Reports for Per Diem
and Special Needs Grants—300.
f. Homeless Providers Grant and Per
Diem Program, Technical Assistance
Application, VA Form 10–0361–TA—
25.
g. Compliance Reports for Technical
Assistance Grants—10.
Dated: June 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012–16102 Filed 6–29–12; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0165]
Agency Information Collection
(Financial Status Report) Activities
Under OMB Review
Office of Management,
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 Office of
Management, Department of Veterans
Affairs, has submitted 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 August 1, 2012.
ADDRESSES: Submit written comments
on the collection of information through
www.Regulations.gov or to VA’s OMB
Desk Officer, Office of Information and
Regulatory Affairs, New Executive
Office Building, Room 10235,
Washington, DC 20503 (202) 395–7316.
Please refer to ‘‘OMB Control No. 2900–
0165’’ 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) 632–
7479, FAX (202) 632–7634 or email
denise.mclamb@va.gov. Please refer to
‘‘OMB Control No. 2900–0165.’’
SUPPLEMENTARY INFORMATION: Title:
Financial Status Report, VA Form 5655.
OMB Control Number: 2900–0165.
PO 00000
Frm 00136
Fmt 4703
Sfmt 4703
39343
Type of Review: Extension of a
currently approved collection.
Abstract: Claimants complete VA
Form 5655 to report their financial
status. VA uses the data collected to
determine the claimant’s eligibility for a
waiver of collection, setup a payment
plan or for the acceptance of a
compromise offer on their VA benefit
debt.
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
12, 2012, at page 22068.
Affected Public: Individuals or
households.
Estimated Annual Burden: 57,155
hours.
Estimated Average Burden Per
Respondent: 1 hour.
Frequency of Response: On occasion.
Estimated Number of Respondents:
57,155.
Dated: June 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012–16103 Filed 6–29–12; 8:45 am]
BILLING CODE A320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0002]
Agency Information Collection
(Income-Net Worth and Employment
Statement) 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, 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 August 1, 2012.
ADDRESSES: Submit written comments
on the collection of information through
www.Regulations.gov or to VA’s OMB
Desk Officer, OMB Human Resources
SUMMARY:
E:\FR\FM\02JYN1.SGM
02JYN1
Agencies
[Federal Register Volume 77, Number 127 (Monday, July 2, 2012)]
[Notices]
[Pages 39342-39343]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-16102]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0554]
Proposed Information Collection (Homeless Providers Grant and Per
Diem Program) Activity; 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 revision of
a currently approved collection, and allow 60 days for public comment
in response to the notice. This notice solicits comments on the
information needed to determine an applicant's eligibility to receive a
grant and/or per diem for programs to assist homeless veterans'
transition to independent living and to determine if the grantee is
meeting the objectives outlined in the original grant application.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before August 31, 2012.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at www.Regulations.gov;
or to Cynthia Harvey-Pryor, Veterans Health Administration (10P7BFP),
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC
20420; or email: cynthia.harvey-pryor@va.gov. Please refer to ``OMB
Control No. 2900-0554'' in any correspondence. During the comment
period, comments may be viewed online through the FDMS.
FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461-5870 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 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. Homeless Providers Grant and Per Diem Program, Capital Grant.
Application, VA Form 10-0361-CG.
b. Homeless Providers Grant and Per Diem Program, Life Safety Code
Application, VA Form 10-0361-LSC.
c. Homeless Providers Grant and Per Diem Program, Per Diem Only
Application, VA Form 10-0361-PDO.
d. Homeless Providers Grant and Per Diem Program, Special Needs
Application, VA Form 10-0361-SN.
e. Compliance Reports for Per Diem and Special Needs Grants. No
form needed. May be reported to VA in standard business narrative.
f. Homeless Providers Grant and Per Diem Program, Technical
Assistance Application, VA Form 10-0361-TA.
g. Compliance Reports for Technical Assistance Grants. No form
needed. May be reported to VA in standard business narrative.
OMB Control Number: 2900-0554.
Type of Review: Revision of a currently approved collection.
Abstract: VA Form 10-0361 series, Homeless Providers Grant and Per
Diem Program, will be used to evaluate applicants eligibility to
receive a grant and/or per diem payments, apply the specific criteria
to rate and rank each application; and to obtain information necessary
to ensure that Federal funds are awarded to applicants who are
financially stable and who will conduct
[[Page 39343]]
the program for which grant and/or per diem award was made.
Affected Public: Not-for-profit institutions.
Estimated Annual Burden:
a. Homeless Providers Grant and Per Diem Program, Capital Grant.
Application, VA Form 10-0361-CG--3,500 hours.
b. Homeless Providers Grant and Per Diem Program, Life Safety Code
Application, VA Form 10-0361-LSC--2,000 hours.
c. Homeless Providers Grant and Per Diem Program, Per Diem Only
Application, VA Form 10-0361-PDO--3,000 hours.
d. Homeless Providers Grant and Per Diem Program, Special Needs
Application, VA Form 10-0361-SN--4,000 hours.
e. Compliance Reports for Per Diem and Special Needs Grants--1,500
hours.
f. Homeless Providers Grant and Per Diem Program, Technical
Assistance Application, VA Form 10-0361-TA--250 hours.
g. Compliance Reports for Technical Assistance Grants--90 hours.
Estimated Average Burden per Respondent:
a. Homeless Providers Grant and Per Diem Program, Capital Grant
Application, VA Form 10-0361-CG--35 hours.
b. Homeless Providers Grant and Per Diem Program, Life Safety Code
Application, VA Form 10-0361-LSC--10 hours.
c. Homeless Providers Grant and Per Diem Program, Per Diem Only
Application, VA Form 10-0361-PDO--20 hours.
d. Homeless Providers Grant and Per Diem Program, Special Needs
Application, VA Form 10-0361-SN--20 hours.
e. Compliance Reports for Per Diem and Special Needs Grants--5
hours.
f. Homeless Providers Grant and Per Diem Program, Technical
Assistance Application, VA Form 10-0361-TA--10 hours.
g. Compliance Reports for Technical Assistance Grants--2.25 hours.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Homeless Providers Grant and Per Diem Program, Capital Grant
Application, VA Form 10-0361-CG--100.
b. Homeless Providers Grant and Per Diem Program, Life Safety Code
Application, VA Form 10-0361-LSC--200.
c. Homeless Providers Grant and Per Diem Program, Per Diem Only
Application, VA Form 10-0361-PDO--150.
d. Homeless Providers Grant and Per Diem Program, Special Needs
Application, VA Form 10-0361-SN--200.
e. Compliance Reports for Per Diem and Special Needs Grants--300.
f. Homeless Providers Grant and Per Diem Program, Technical
Assistance Application, VA Form 10-0361-TA--25.
g. Compliance Reports for Technical Assistance Grants--10.
Dated: June 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012-16102 Filed 6-29-12; 8:45 am]
BILLING CODE 8320-01-P