Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes): Comment Request, 45719-45720 [2012-18732]
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Federal Register / Vol. 77, No. 148 / Wednesday, August 1, 2012 / Notices
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: Preliminary Independent Living
(IL) Assessment, VA Form 28–0791.
OMB Control Number: 2900–0681.
Type of Review: Extension of a
currently approved collection.
Abstract: VA case managers use VA
Form 28–0791 while evaluating the
independent living needs of veterans
with severe disabilities. The data is used
to determine the scope of the veteran’s
independent living needs under the
Vocational Rehabilitation and
Employment program.
Affected Public: Individuals or
households.
Estimated Annual Burden: 2,500.
Estimated Average Burden per
Respondent: 1 hour.
Frequency of Response: One-time.
Estimated Number of Respondents:
2,500.
Dated: July 27, 2012.
By direction of the Secretary:
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012–18731 Filed 7–31–12; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0160]
Proposed Information Collection (Per
Diem for Nursing Home Care of
Veterans in State Homes; Per Diem for
Adult Day Care of Veterans in State
Homes): 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
extension 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 ensure that nursing home and
tkelley on DSK3SPTVN1PROD with NOTICES
SUMMARY:
VerDate Mar<15>2010
19:53 Jul 31, 2012
Jkt 226001
adult day health care facilities are
providing high quality services to
Veterans in State homes.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before October 1, 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 ‘‘2900–0160’’ 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. Title 38, CFR Parts 51 and 52, State
Home Programs.
b. State Home Inspection—Staffing
Profile, VA Form 10–3567.
c. State Home Report and Statement
of Federal Aid Claimed, VA Form 10–
5588.
d. State Home Program Application
for Veteran Care—Medical Certification,
VA Form 10–10SH.
e. Department of Veterans Affairs
Certification Regarding Drug-Free
Workplace Requirements for Grantees
Other Than Individuals, VA Form 10–
0143.
f. Statement of Assurance of
Compliance with Section 504 of the
PO 00000
Frm 00145
Fmt 4703
Sfmt 4703
45719
Rehabilitation Act of 1973, VA Form
10–0143a.
g. Certification Regarding Lobbying,
VA Form 10–0144.
h. Statement of Assurance of
Compliance with Equal Opportunity
Laws, VA Form 10–0144a.
OMB Control Number: 2900–0160.
Type of Review: Extension of a
currently approved collection.
Abstract: VA pays per diem to State
homes providing nursing home and
adult day health services care to
Veterans. VA requires facilities
providing nursing home and adult day
health care to furnish an application for
recognition based on certification;
appeal information, application and
justification for payment; records and
reports which facility management must
maintain regarding activities of
residents or participants; information
relating to whether the facility meets
standards concerning residents’ rights
and responsibilities prior to admission
or enrollment, during admission or
enrollment, and upon discharge; the
records and reports which facilities
management and health care
professionals must maintain regarding
residents or participants and employees;
documents pertain to the management
of the facilities; food menu planning;
pharmaceutical records; and life safety
documentation. Without access to such
information, VA would not be able to
determine whether high quality care is
being provided to Veterans.
Affected Public: State, Local or Tribal
Government.
Estimated Total Annual Burden:
a. Title 38, CFR Parts 51 and 52, State
Home Programs—3,738 hours.
b. State Home Inspection Staffing
Profile, VA Form 10–3567—90 hours.
c. State Home Report and Statement
of Federal Aid Claimed, VA Form 10–
5588—1,080 hours.
d. State Home Program Application
for Veteran Care—Medical Certification,
VA Form 10–10SH—10,566 hours.
e. Department of Veterans Affairs
Certification Regarding Drug-Free
Workplace Requirements for Grantees
Other Than Individuals, VA Form 10–
0143—15 hours.
f. Statement of Assurance of
Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form
10–1043a—15 hours.
g. Certification Regarding Lobbying,
VA Form 10–0144—15 hours.
h. Statement of Assurance of
Compliance with Equal Opportunity
Laws, VA Form 10–0144a—15 hours.
Estimated Average Burden per
Respondent:
a. Title 38, CFR Parts 51 and 52, State
Home Programs—7 minutes.
E:\FR\FM\01AUN1.SGM
01AUN1
45720
Federal Register / Vol. 77, No. 148 / Wednesday, August 1, 2012 / Notices
tkelley on DSK3SPTVN1PROD with NOTICES
b. State Home Inspection Staffing
Profile, VA Form 10–3567—30 minutes.
c. State Home Report and Statement
of Federal Aid Claimed, VA Form 10–
5588—30 minutes.
d. State Home Program Application
for Veteran Care—Medical Certification,
VA Form 10–10SH—30 minutes.
e. Department of Veterans Affairs
Certification Regarding Drug-Free
Workplace Requirements for Grantees
Other Than Individuals, VA Form 10–
0143—5 minutes.
f. Statement of Assurance of
Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form
10–1043a—5 minutes.
g. Certification Regarding Lobbying,
VA Form 10–0144—5 minutes.
h. Statement of Assurance of
Compliance with Equal Opportunity
Laws, VA Form 10–0144a—5 minutes.
Frequency of Response: One-time.
Estimated Number of Respondents:
a. Title 38, CFR Parts 51 and 52, State
Home Programs—22,926.
VerDate Mar<15>2010
19:53 Jul 31, 2012
Jkt 226001
b. State Home Inspection Staffing
Profile, VA Form 10–3567—180.
c. State Home Report and Statement
of Federal Aid Claimed, VA Form 10–
5588—180.
d. State Home Program Application
for Veteran Care—Medical Certification,
VA Form 10–10SH—21,132.
e. Department of Veterans Affairs
Certification Regarding Drug-Free
Workplace Requirements for Grantees
Other Than Individuals, VA Form 10–
0143—180.
f. Statement of Assurance of
Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form
10–1043a—180.
g. Certification Regarding Lobbying,
VA Form 10–0144—180.
h. Statement of Assurance of
Compliance with Equal Opportunity
Laws, VA Form 10–0144a—180.
Estimated Total Annual Responses:
a. Title 38, CFR Parts 51 and 52, State
Home Programs—23,466.
b. State Home Inspection Staffing
Profile, VA Form 10–3567—180.
PO 00000
Frm 00146
Fmt 4703
Sfmt 9990
c. State Home Report and State of
Federal Aid Claimed, VA Form 10–
5588—2,160.
d. State Home Program Application
for Veteran Care—Medical Certification,
VA Form 10–10SH—21,132.
e. Department of Veterans Affairs
Certification Regarding Drug-Free
Workplace Requirements for Grantees
Other Than Individuals, VA Form 10–
0143—180.
f. Statement of Assurance of
Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form
10–1043a—180.
g. Certification Regarding Lobbying,
VA Form 10–0144—180.
h. Statement of Assurance of
Compliance with Equal Opportunity
Laws, VA Form 10–0144a—180.
Dated: July 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012–18732 Filed 7–31–12; 8:45 am]
BILLING CODE 8320–01–P
E:\FR\FM\01AUN1.SGM
01AUN1
]]>Agencies
[Federal Register Volume 77, Number 148 (Wednesday, August 1, 2012)]
[Notices]
[Pages 45719-45720]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-18732]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0160]
Proposed Information Collection (Per Diem for Nursing Home Care
of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in
State Homes): 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 extension 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 ensure that nursing home and
adult day health care facilities are providing high quality services to
Veterans in State homes.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before October 1, 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 ``2900-0160'' 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. Title 38, CFR Parts 51 and 52, State Home Programs.
b. State Home Inspection--Staffing Profile, VA Form 10-3567.
c. State Home Report and Statement of Federal Aid Claimed, VA Form
10-5588.
d. State Home Program Application for Veteran Care--Medical
Certification, VA Form 10-10SH.
e. Department of Veterans Affairs Certification Regarding Drug-Free
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143.
f. Statement of Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form 10-0143a.
g. Certification Regarding Lobbying, VA Form 10-0144.
h. Statement of Assurance of Compliance with Equal Opportunity
Laws, VA Form 10-0144a.
OMB Control Number: 2900-0160.
Type of Review: Extension of a currently approved collection.
Abstract: VA pays per diem to State homes providing nursing home
and adult day health services care to Veterans. VA requires facilities
providing nursing home and adult day health care to furnish an
application for recognition based on certification; appeal information,
application and justification for payment; records and reports which
facility management must maintain regarding activities of residents or
participants; information relating to whether the facility meets
standards concerning residents' rights and responsibilities prior to
admission or enrollment, during admission or enrollment, and upon
discharge; the records and reports which facilities management and
health care professionals must maintain regarding residents or
participants and employees; documents pertain to the management of the
facilities; food menu planning; pharmaceutical records; and life safety
documentation. Without access to such information, VA would not be able
to determine whether high quality care is being provided to Veterans.
Affected Public: State, Local or Tribal Government.
Estimated Total Annual Burden:
a. Title 38, CFR Parts 51 and 52, State Home Programs--3,738 hours.
b. State Home Inspection Staffing Profile, VA Form 10-3567--90
hours.
c. State Home Report and Statement of Federal Aid Claimed, VA Form
10-5588--1,080 hours.
d. State Home Program Application for Veteran Care--Medical
Certification, VA Form 10-10SH--10,566 hours.
e. Department of Veterans Affairs Certification Regarding Drug-Free
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--15 hours.
f. Statement of Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form 10-1043a--15 hours.
g. Certification Regarding Lobbying, VA Form 10-0144--15 hours.
h. Statement of Assurance of Compliance with Equal Opportunity
Laws, VA Form 10-0144a--15 hours.
Estimated Average Burden per Respondent:
a. Title 38, CFR Parts 51 and 52, State Home Programs--7 minutes.
[[Page 45720]]
b. State Home Inspection Staffing Profile, VA Form 10-3567--30
minutes.
c. State Home Report and Statement of Federal Aid Claimed, VA Form
10-5588--30 minutes.
d. State Home Program Application for Veteran Care--Medical
Certification, VA Form 10-10SH--30 minutes.
e. Department of Veterans Affairs Certification Regarding Drug-Free
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--5 minutes.
f. Statement of Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form 10-1043a--5 minutes.
g. Certification Regarding Lobbying, VA Form 10-0144--5 minutes.
h. Statement of Assurance of Compliance with Equal Opportunity
Laws, VA Form 10-0144a--5 minutes.
Frequency of Response: One-time.
Estimated Number of Respondents:
a. Title 38, CFR Parts 51 and 52, State Home Programs--22,926.
b. State Home Inspection Staffing Profile, VA Form 10-3567--180.
c. State Home Report and Statement of Federal Aid Claimed, VA Form
10-5588--180.
d. State Home Program Application for Veteran Care--Medical
Certification, VA Form 10-10SH--21,132.
e. Department of Veterans Affairs Certification Regarding Drug-Free
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--180.
f. Statement of Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form 10-1043a--180.
g. Certification Regarding Lobbying, VA Form 10-0144--180.
h. Statement of Assurance of Compliance with Equal Opportunity
Laws, VA Form 10-0144a--180.
Estimated Total Annual Responses:
a. Title 38, CFR Parts 51 and 52, State Home Programs--23,466.
b. State Home Inspection Staffing Profile, VA Form 10-3567--180.
c. State Home Report and State of Federal Aid Claimed, VA Form 10-
5588--2,160.
d. State Home Program Application for Veteran Care--Medical
Certification, VA Form 10-10SH--21,132.
e. Department of Veterans Affairs Certification Regarding Drug-Free
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--180.
f. Statement of Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, VA Form 10-1043a--180.
g. Certification Regarding Lobbying, VA Form 10-0144--180.
h. Statement of Assurance of Compliance with Equal Opportunity
Laws, VA Form 10-0144a--180.
Dated: July 27, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012-18732 Filed 7-31-12; 8:45 am]
BILLING CODE 8320-01-P
