Proposed Information Collection (Request for and Authorization To Release Medical Records or Health Information) Activity: Comment Request, 42555-42556 [2012-17506]

Download as PDF Federal Register / Vol. 77, No. 139 / Thursday, July 19, 2012 / Notices ACTION: Notice. 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, 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 and includes the actual data collection instrument. SUMMARY: Comments must be submitted on or before August 20, 2012. DATES: Submit written comments on the collection of information through 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– 0113’’ in any correspondence. ADDRESSES: 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) 632–7583 or email denise.mclamb@mail.va.gov. Please refer to ‘‘OMB Control No. 2900–0113.’’ emcdonald on DSK67QTVN1PROD with NOTICES SUPPLEMENTARY INFORMATION: Title: Application for Fee or Personnel Designation, VA Form 26–6681. OMB Control Number: 2900–0113. Type of Review: Extension of a currently approved collection. Abstract: Applicants complete VA Form 26–6681 to apply for a position as a designate fee appraiser or compliance inspector. VA will use the data collected to determine the applicant’s experience in the real estate valuation field. 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 May 10, 2012, at page 27543. Affected Public: Individuals or households. Estimated Annual Burden: 1,000 hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One-time. Estimated Number of Respondents: 2,000. Dated: July 13, 2012. VerDate Mar<15>2010 15:07 Jul 18, 2012 Jkt 226001 By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2012–17508 Filed 7–18–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0260] Proposed Information Collection (Request for and Authorization To Release Medical Records or Health Information) Activity: Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: 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 revision 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 obtain a patient written consent to disclose medical records or health information to individuals or third parties. DATES: Written comments and recommendations on the proposed collection of information should be received on or before September 17, 2012. ADDRESSES: Submit written comments on the collection of information through the 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 ‘‘2900–0260’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461–5870 or Fax (202) 273–9387. 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 SUMMARY: PO 00000 Frm 00074 Fmt 4703 Sfmt 4703 42555 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. Request for and Authorization to Release Medical Records or Health Information, VA Form 10–5345. b. Individual’s Request for a Copy of their Own Health Information, VA Form 10–5345a. c. My HealtheVet (MHV)— Individuals’ Request for a Copy of Their Own Health Information, VA Form 10– 5345a–MHV. d. Restriction of the Release of Individually-Identifiable Health Information through Nationwide Health Information Network (NwHIN), VA Form 10–0525a. e. Request for and Authorization to Release Protected Health Information to Nationwide Health Information Network, VA Form 10–0485. OMB Control Number: 2900–0260. Type of Review: Revision of a currently approved collection. Abstracts: a. VA Form 10–5345 is used to obtain a written consent from patients before information concerning his or her treatment for alcoholism or alcohol abuse, drug abuse, sickle cell anemia, or infection with the human immunodeficiency virus (HIV) can be disclosed to private insurance companies, physicians and other third parties. b. Patients complete VA Form 10– 5345a to request a copy of their health information maintained at Department of Veterans Affairs. c. VA Form 10–5345a–MHV is completed by individuals requesting their health information electronically through My HealtheVet. d. VA Form 10–0525a is completed by individuals to restrict the sharing their electronic health information through the NWHIN. e. VA Form 10–0485 is used to electronically exchange protected health information between VA and approved E:\FR\FM\19JYN1.SGM 19JYN1 42556 Federal Register / Vol. 77, No. 139 / Thursday, July 19, 2012 / Notices Nationwide Health Information Network participants. Affected Public: Individuals or households. Estimated Total Annual Burden a. VA Form 10–5345—10,000 hours. b. VA Form 10–5345a—15,000 hours. c. VA Form 10–5345a–MVH—35,000 hours. d. VA Form 10–0525a—50 hours. e. VA Form 10–0485—500 hours. Estimated Average Burden Per Respondent—2 minutes for VA Form 10–5345 and 3 minutes for VA Forms 10–5345a, 10–5345a–MVH, 10–0525a, 10–0485. Frequency of Response: On occasion. Estimated Number of Respondents: a. VA Form 10–5345—300,000. b. VA Form 10–5345a—300,000. c. 10–5345a–MVH—700,000. d. VA Form 10–0525a—1,000. e. VA Form 10–0485—10,000. Dated: July 13, 2012. By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2012–17506 Filed 7–18–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–NEW (VA Form 21– 0958)] Proposed Information Collection (Notice of Disagreement) Activity: Comment Request Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: The Veterans Benefits Administration (VBA), 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 new collection, and allow 60 days for public comment in response to the notice. This notice solicits comments for information needed to indicate disagreement with a decision issues by a Regional Office. DATES: Written comments and recommendations on the proposed collection of information should be received on or before September 17, 2012. emcdonald on DSK67QTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 15:07 Jul 18, 2012 Jkt 226001 Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420 or email to nancy.kessinger@va.gov. Please refer to ‘‘OMB Control No. 2900–NEW 21– 0958’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632–8924 or Fax (202) 275–5947. 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, VBA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VBA’s functions, including whether the information will have practical utility; (2) the accuracy of VBA’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: Notice of Disagreement, VA Form 21–0958. OMB Control Number: 2900–NEW. Type of Review: New data collection. Abstract: Veterans complete VA Form 21–0958 to indicate disagreement with a decision issued by Regional Office. This is the first step in the appeal process. The respondent may or may not continue with an appeal to the Board of Veterans Appeals (BVA). If the Veteran opts to continue to BVA for an appeal, this form will be included in the claim folder as evidence. Affected Public: Individuals or households. Estimated Annual Burden: 65,000 hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One-time. Estimated Number of Respondents: 130,000. ADDRESSES: PO 00000 Dated: July 13, 2012. Frm 00075 Fmt 4703 Sfmt 4703 By direction of the Secretary. Denise McLamb, Program Analyst, Enterprise Records Service. [FR Doc. 2012–17505 Filed 7–18–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0739] Proposed Information Collection (Access to Financial Records) Activity: Comment Request Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: The Veterans Benefits Administration (VBA), 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 request the addresses of beneficiaries whose VA payments are deposited into financial institutions. DATES: Written comments and recommendations on the proposed collection of information should be received on or before September 17, 2012. ADDRESSES: Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email to nancy.kessinger@va.gov. Please refer to ‘‘OMB Control No. 2900–0739’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632–8924 or Fax (202) 275–5947. 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. SUMMARY: E:\FR\FM\19JYN1.SGM 19JYN1

Agencies

[Federal Register Volume 77, Number 139 (Thursday, July 19, 2012)]
[Notices]
[Pages 42555-42556]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-17506]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0260]


Proposed Information Collection (Request for and Authorization To 
Release Medical Records or Health Information) Activity: 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 revision 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 obtain a patient written consent to 
disclose medical records or health information to individuals or third 
parties.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before September 17, 2012.

ADDRESSES: Submit written comments on the collection of information 
through the 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 ``2900-0260'' in any correspondence. During the comment 
period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461-5870 or 
Fax (202) 273-9387.

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. Request for and Authorization to Release Medical Records or 
Health Information, VA Form 10-5345.
    b. Individual's Request for a Copy of their Own Health Information, 
VA Form 10-5345a.
    c. My HealtheVet (MHV)--Individuals' Request for a Copy of Their 
Own Health Information, VA Form 10-5345a-MHV.
    d. Restriction of the Release of Individually-Identifiable Health 
Information through Nationwide Health Information Network (NwHIN), VA 
Form 10-0525a.
    e. Request for and Authorization to Release Protected Health 
Information to Nationwide Health Information Network, VA Form 10-0485.
    OMB Control Number: 2900-0260.
    Type of Review: Revision of a currently approved collection.
    Abstracts:
    a. VA Form 10-5345 is used to obtain a written consent from 
patients before information concerning his or her treatment for 
alcoholism or alcohol abuse, drug abuse, sickle cell anemia, or 
infection with the human immunodeficiency virus (HIV) can be disclosed 
to private insurance companies, physicians and other third parties.
    b. Patients complete VA Form 10-5345a to request a copy of their 
health information maintained at Department of Veterans Affairs.
    c. VA Form 10-5345a-MHV is completed by individuals requesting 
their health information electronically through My HealtheVet.
    d. VA Form 10-0525a is completed by individuals to restrict the 
sharing their electronic health information through the NWHIN.
    e. VA Form 10-0485 is used to electronically exchange protected 
health information between VA and approved

[[Page 42556]]

Nationwide Health Information Network participants.
    Affected Public: Individuals or households.

Estimated Total Annual Burden

    a. VA Form 10-5345--10,000 hours.
    b. VA Form 10-5345a--15,000 hours.
    c. VA Form 10-5345a-MVH--35,000 hours.
    d. VA Form 10-0525a--50 hours.
    e. VA Form 10-0485--500 hours.
    Estimated Average Burden Per Respondent--2 minutes for VA Form 10-
5345 and 3 minutes for VA Forms 10-5345a, 10-5345a-MVH, 10-0525a, 10-
0485.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. VA Form 10-5345--300,000.
    b. VA Form 10-5345a--300,000.
    c. 10-5345a-MVH--700,000.
    d. VA Form 10-0525a--1,000.
    e. VA Form 10-0485--10,000.

    Dated: July 13, 2012.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012-17506 Filed 7-18-12; 8:45 am]
BILLING CODE 8320-01-P
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