Agency Information Collection: Emergency Submission for OMB Review (PACT: Clinical Innovation Study-Helping Veterans Manage Chronic Pain); Comment Request, 50547-50548 [2012-20457]

Download as PDF pmangrum on DSK3VPTVN1PROD with NOTICES Federal Register / Vol. 77, No. 162 / Tuesday, August 21, 2012 / Notices Office of Management and Budget (OMB) the following emergency proposal for the collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. 3507(j)(1)). An emergency clearance is being requested for information needed to improve patient care through specific mechanisms. VA has undertaken an initiative to implement a patientcentered medical home model, ‘‘Patient Aligned Care Team’’ or PACT at all Veterans Health Administration (VHA) Ambulatory Primary Care sites. This initiative supports the VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. The patient experiences from this data collection are intended to help form future national VA policy. DATES: Comments must be submitted on or before August 31, 2012. ADDRESSES: Send comments and recommendations concerning any aspect of the information collection to VA’s OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503 (202) 395–7316 or Fax (202) 395–6974. Please refer to ‘‘2900–New (VA Form 10–0536).’’ 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@va.gov. Please refer to ‘‘OMB Control No. 2900–New (VA Form 10–0536). SUPPLEMENTARY INFORMATION: Title: PACT Patient Experiences Survey, VA Form 10–0536. OMB Control Number: 2900—New. Type of Review: New data collection. Abstract: The data collected on VA Form 10–0536 will be used to implement a patient-centered medical home at all Veterans Health Administration Ambulatory Primary Care sites. The medical home provides accessible, coordinated, comprehensive, patient-centered care, and is managed by primary care providers with the active involvement of other clinical and non-clinical staff. The medical home allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions. The information collected will be used by the VAAAHS PACT Demonstration Laboratory and the Ambulatory Care Service to evaluate the universal VHA VerDate Mar<15>2010 15:31 Aug 20, 2012 Jkt 226001 PACT Systems Redesign, document patient experiences over time, and improve patient care through specific mechanisms. Affected Public: Individuals or households. Estimated Annual Burden: 2,400 hours. Estimated Average Burden Per Respondent: 30 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 2,400. Estimated Number of Responses: 4,800. Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20455 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900—New VA Form (VA Form 10–0532a–k)] Agency Information Collection: Emergency Submission for OMB Review (PACT: Clinical Innovation Study—Helping Veterans Manage Chronic Pain); Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C., 3501–3521), this notice announces that the Department of Veterans Affairs (VA), will submit to the Office of Management and Budget (OMB) the following emergency proposal for the collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. 3507(j)(1)). An emergency clearance is being requested for information needed to assess the effectiveness of pain care management provided to veterans. DATES: Comments must be submitted on or before August 31, 2012. ADDRESSES: Send comments and recommendations concerning any aspect of the information collection to VA’s OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503, (202) 395–7316 or Fax (202) 395–6974. Please refer to ‘‘2900—New VA Form (VA Form 10– 0532a–k). FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records SUMMARY: PO 00000 Frm 00091 Fmt 4703 Sfmt 4703 50547 Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 632– 7479, Fax (202) 632–7583 or email: denise.mclamb@va.gov. Please refer to ‘‘OMB Control No. 2900—New VA Form (VA Form 10–0532a–k).’’ SUPPLEMENTARY INFORMATION: Titles: Clinical Innovation Study— Helping Veterans Manage Chronic Pain. a. Pain Care Management Tracking Tool, VA Form 10–0532. b. Pain Care Management Self Monitoring Form (unpublished), VA Form 10–0532a. c. Pain Outcomes Questionnaire (Clark, Gironda, & Young, 2003), VA Form 10–0532b. d. The Multidimensional Pain Inventory (MPI; Kearns, Turk, & Rudy, 1985), VA Form 10–0532c. e. Pain Catastrophizing Scale (Osman, Barrios, Gutierrez, Kopper, Merrifield, & Grittmann, 2000), VA Form 10–0532d. f. The Oswestry Disability Index (Fairbank & Pynsent, 2000), VA Form 10–0532e. g. Brief Pain Inventory—Short Form (BPI; Cleeland, 1991). Administered at baseline and each follow-up, VA Form 10–0532f. h. Fear-Avoidance Beliefs Questionnaire (FABQ; Waddell, Newton, et al., 1993), VA Form 10– 0532g. i. The Brief COPE (Carver, 1997), VA Form 10–0532h. j. Depression and Anxiety Stress Scales (DASS–21; Lovibond & Lovibond, 1995), VA Form 10–0532i. k. Patient Health Questionnaire (PHQ–9; Kroenke, Spitzer, & Williams, 2001), VA Form 10–0532j. l. Generalized Anxiety Disorder (GAD–7); Spitzer, Kroenke, Williams, & Lowe, 2006), VA Form 10–0532k. OMB Control Number: 2900–New. Type of Review: New data collection. Abstract: The data collected on VA Forms VA Form 10–0532a–k will be used to: (1) Assess the effectiveness of patient care management (PCM) in increasing patients’ functionality, improving quality of life, and improving paint control relative to usual care and (2) to assess the impact of PCM on depression and anxiety relative to usual care. This data collection’s model has been designed to serve patients by augmenting existing pain management interventions (e.g., medications, physical therapy) by teaching pain care management skills that patients can incorporate into their daily activities. VA will use the information to evaluate the effectiveness of the intervention so that it can most effectively be applied to future patients with chronic pain problems. E:\FR\FM\21AUN1.SGM 21AUN1 50548 Federal Register / Vol. 77, No. 162 / Tuesday, August 21, 2012 / Notices Affected Public: Individuals or households. Estimated Annual Burden: a. VA Form 10–0532—67 hours. b. VA Form 10–0532a—80 hours. c. VA Form 10–0532b—200 hours. d. VA Form 10–0532c—80 hours. e. VA Form 10–0532d—53 hours. f. VA Form 10–0532e—53 hours. g. VA Form 10–0532f—133 hours. h. VA Form 10–0532g—19 hours. i. VA Form 10–0532h—27 hours. j. VA Form 10–0532i—93 hours. k. VA Form 10–0532j– 67 hours. l. VA Form 10–0532k—67 hours. Estimated Average Burden per Respondent: a. VA Form 10–0532—5 minutes. b. VA Form 10–0532a—10 minutes. c. VA Form 10–0532b—15 minutes. d. VA Form 10–0532c—15 minutes. e. VA Form 10–0532d—10 minutes. f. VA Form 10–0532e—10 minutes. g. VA Form 10–0532f—10 minutes. h. VA Form 10–0532g—7 minutes. i. VA Form 10–0532h—10 minutes. j. VA Form 10–0532i—7 minutes. k. VA Form 10–0532j—5 minutes. l. VA Form 10–0532k—5 minutes, Frequency of Response: Monthly. Estimated Number of Respondents: a. VA Form 10–0532—800. b. VA Form 10–0532a—480. c. VA Form 10–0532b—800. d. VA Form 10–0532c—320. e. VA Form 10–0532d—320. f. VA Form 10–0532e—320. g. VA Form 10–0532f—800. h. VA Form 10–0532g—160. i. VA Form 10–0532h—160. j. VA Form 10–0532i—800. k. VA Form 10–0532j—800. l. VA Form 10–0532k—800 Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20457 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS pmangrum on DSK3VPTVN1PROD with NOTICES [OMB Control No. 2900–New (Patient & Caregiver)] Agency Information Collection: (PACT Qualitative Evaluation: Patient & Caregiver Interviews); Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995 SUMMARY: VerDate Mar<15>2010 15:31 Aug 20, 2012 Jkt 226001 (44 U.S.C., 3501–3521), this notice announces that the Department of Veterans Affairs (VA), will submit to the Office of Management and Budget (OMB) the following emergency proposal for the collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. 3507(j)(1)). An emergency clearance is being requested for information needed to evaluate the universal Patient Aligned Care Teams (PACT) Systems Redesign, document patients’ and their informal caregivers’ experience. DATES: Comments must be submitted on or before August 31, 2012. ADDRESSES: Send comments and recommendations concerning any aspect of the information collection to VA’s OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503 (202) 395–7316 or FAX (202) 395–6974. Please refer to ‘‘2900–New (Patient & Caregiver). 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@va.gov. Please refer to ‘‘OMB Control No. 2900–New (Patient & Caregiver). SUPPLEMENTARY INFORMATION: Title: PACT Qualitative Evaluation: Patient & Caregiver Interviews. OMB Control Number: 2900—New Type of Review: New data collection. Abstract: The information collected will be used assess patients’ and caregivers’ experiences with the PACT Systems Redesign and the PACT Demo Lab innovations and will inform the redesign and demo lab innovations in real time. It will also gather information on patient characteristics and their experiences with self-managing chronic conditions, using technology to care for their health, and involving friends and family members in their health care. The information collected will be used by the PACT Demonstration Laboratory and the Ambulatory Care Service to evaluate the universal VHA PACT Systems Redesign, document patients’ and their informal caregivers’ experiences over time, and improve patient care through specific mechanisms. Affected Public: Individuals or households. Estimated Annual Burden: 50 burden hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One-time. PO 00000 Frm 00092 Fmt 4703 Sfmt 4703 Estimated Number of Respondents: 100. Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20462 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-New (VA Form 10– 0537)] Agency Information Collection: (PACT Clinical Innovation Study: Engaging Caregivers in the Care of Veterans With Dementia); Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C., 3501–3521), this notice announces that the Department of Veterans Affairs (VA), will submit to the Office of Management and Budget (OMB) the following emergency proposal for the collection of information under the provisions of the Paperwork Reduction Act (44 U.S.C. 3507(j)(1)). An emergency clearance is being requested for information needed to improve dementia care for patients and care givers. DATES: Comments must be submitted on or before August 31, 2012. ADDRESSES: Send comments and recommendations concerning any aspect of the information collection to VA’s OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503 (202) 395–7316 or Fax (202) 395–6974. Please refer to ‘‘2900—New (VA Form 10–0537). 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@va.gov. Please refer to ‘‘OMB Control No. 2900—New (VA Form 10–0537). SUPPLEMENTARY INFORMATION: Title: PACT Clinical Innovation Study: Engaging Caregivers in the Care of Veterans with Dementia, VA Form 10–0537, Appendices a–u. OMB Control Number: 2900—New. Type of Review: New data collection. SUMMARY: E:\FR\FM\21AUN1.SGM 21AUN1

Agencies

[Federal Register Volume 77, Number 162 (Tuesday, August 21, 2012)]
[Notices]
[Pages 50547-50548]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-20457]


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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900--New VA Form (VA Form 10-0532a-k)]


Agency Information Collection: Emergency Submission for OMB 
Review (PACT: Clinical Innovation Study--Helping Veterans Manage 
Chronic Pain); Comment Request

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., 3501-3521), this notice announces that the Department of 
Veterans Affairs (VA), will submit to the Office of Management and 
Budget (OMB) the following emergency proposal for the collection of 
information under the provisions of the Paperwork Reduction Act (44 
U.S.C. 3507(j)(1)). An emergency clearance is being requested for 
information needed to assess the effectiveness of pain care management 
provided to veterans.

DATES: Comments must be submitted on or before August 31, 2012.

ADDRESSES: Send comments and recommendations concerning any aspect of 
the information collection to VA's OMB Desk Officer, OMB Human 
Resources and Housing Branch, New Executive Office Building, Room 
10235, Washington, DC 20503, (202) 395-7316 or Fax (202) 395-6974. 
Please refer to ``2900--New VA Form (VA Form 10-0532a-k).

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@va.gov. Please refer to ``OMB Control No. 2900--New VA 
Form (VA Form 10-0532a-k).''

SUPPLEMENTARY INFORMATION: 
    Titles: Clinical Innovation Study--Helping Veterans Manage Chronic 
Pain.
    a. Pain Care Management Tracking Tool, VA Form 10-0532.
    b. Pain Care Management Self Monitoring Form (unpublished), VA Form 
10-0532a.
    c. Pain Outcomes Questionnaire (Clark, Gironda, & Young, 2003), VA 
Form 10-0532b.
    d. The Multidimensional Pain Inventory (MPI; Kearns, Turk, & Rudy, 
1985), VA Form 10-0532c.
    e. Pain Catastrophizing Scale (Osman, Barrios, Gutierrez, Kopper, 
Merrifield, & Grittmann, 2000), VA Form 10-0532d.
    f. The Oswestry Disability Index (Fairbank & Pynsent, 2000), VA 
Form 10-0532e.
    g. Brief Pain Inventory--Short Form (BPI; Cleeland, 1991). 
Administered at baseline and each follow-up, VA Form 10-0532f.
    h. Fear-Avoidance Beliefs Questionnaire (FABQ; Waddell, Newton, et 
al., 1993), VA Form 10-0532g.
    i. The Brief COPE (Carver, 1997), VA Form 10-0532h.
    j. Depression and Anxiety Stress Scales (DASS-21; Lovibond & 
Lovibond, 1995), VA Form 10-0532i.
    k. Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & 
Williams, 2001), VA Form 10-0532j.
    l. Generalized Anxiety Disorder (GAD-7); Spitzer, Kroenke, 
Williams, & Lowe, 2006), VA Form 10-0532k.
    OMB Control Number: 2900-New.
    Type of Review: New data collection.
    Abstract: The data collected on VA Forms VA Form 10-0532a-k will be 
used to: (1) Assess the effectiveness of patient care management (PCM) 
in increasing patients' functionality, improving quality of life, and 
improving paint control relative to usual care and (2) to assess the 
impact of PCM on depression and anxiety relative to usual care. This 
data collection's model has been designed to serve patients by 
augmenting existing pain management interventions (e.g., medications, 
physical therapy) by teaching pain care management skills that patients 
can incorporate into their daily activities. VA will use the 
information to evaluate the effectiveness of the intervention so that 
it can most effectively be applied to future patients with chronic pain 
problems.

[[Page 50548]]

    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-0532--67 hours.
    b. VA Form 10-0532a--80 hours.
    c. VA Form 10-0532b--200 hours.
    d. VA Form 10-0532c--80 hours.
    e. VA Form 10-0532d--53 hours.
    f. VA Form 10-0532e--53 hours.
    g. VA Form 10-0532f--133 hours.
    h. VA Form 10-0532g--19 hours.
    i. VA Form 10-0532h--27 hours.
    j. VA Form 10-0532i--93 hours.
    k. VA Form 10-0532j- 67 hours.
    l. VA Form 10-0532k--67 hours.
    Estimated Average Burden per Respondent:
    a. VA Form 10-0532--5 minutes.
    b. VA Form 10-0532a--10 minutes.
    c. VA Form 10-0532b--15 minutes.
    d. VA Form 10-0532c--15 minutes.
    e. VA Form 10-0532d--10 minutes.
    f. VA Form 10-0532e--10 minutes.
    g. VA Form 10-0532f--10 minutes.
    h. VA Form 10-0532g--7 minutes.
    i. VA Form 10-0532h--10 minutes.
    j. VA Form 10-0532i--7 minutes.
    k. VA Form 10-0532j--5 minutes.
    l. VA Form 10-0532k--5 minutes,
    Frequency of Response: Monthly.
    Estimated Number of Respondents:
    a. VA Form 10-0532--800.
    b. VA Form 10-0532a--480.
    c. VA Form 10-0532b--800.
    d. VA Form 10-0532c--320.
    e. VA Form 10-0532d--320.
    f. VA Form 10-0532e--320.
    g. VA Form 10-0532f--800.
    h. VA Form 10-0532g--160.
    i. VA Form 10-0532h--160.
    j. VA Form 10-0532i--800.
    k. VA Form 10-0532j--800.
    l. VA Form 10-0532k--800

    Dated: August 16, 2012.

    By direction of the Secretary.

Denise McLamb,
Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20457 Filed 8-20-12; 8:45 am]
BILLING CODE 8320-01-P
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