Agency Information Collection: Emergency Submission for OMB Review (VISN 23 PACT Demonstration Lab: Patient Care Preferences Surveys); Comment Request, 50549-50550 [2012-20458]

Download as PDF Federal Register / Vol. 77, No. 162 / Tuesday, August 21, 2012 / Notices Abstract: The data collected on VA Form 10–0537, Appendices a–u, will be used to examine the feasibility and extent to which a patient-centered and dementia care management program for veterans and their caregivers facilitates access to and use of medical and social services. The information will help VA develop and test a care management intervention that will improve dementia care for patients and family caregivers. Affected Public: Individuals or households. Estimated Annual Burden: 704 hours. Estimated Average Burden per Respondent: 88 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 160. Estimated Number of Responses: 480. Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20461 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900—New (VA Form 10– 0533a–c)] Agency Information Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson’s Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home?); 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 United States 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 the care and clinical outcomes of patients with Parkinson’s disease. 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 pmangrum on DSK3VPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 15:31 Aug 20, 2012 Jkt 226001 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 10–0533a–c). 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 10–0533a–c).’’ SUPPLEMENTARY INFORMATION: Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20456 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P PO 00000 Frm 00093 Fmt 4703 Sfmt 4703 DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900—New (VA Form (10– 0530a–b)] Agency Information Collection: Emergency Submission for OMB Review (VISN 23 PACT Demonstration Lab: Patient Care Preferences Surveys); 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 health care for 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 10–0530a–b). 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 (10–0530a–b). SUPPLEMENTARY INFORMATION: Title: VISN 23 PACT Demonstration Lab: Patient Care Preferences Survey. a. Multidimensional Health Locus of Control, VA Form 10–0530. b. General Adherence Scale, VA Form 10–0530a. c. Demographic Data: Patient Background Information, VA Form 10– 0530b. OMB Control Number: 2900–New. Type of Review: New data collection. Abstract: This patient self-assessment of health study and patient satisfaction questionnaire seek to collect individual, primary data from patients concerning attitudes toward healthcare. The VHA PACT Demo Lab is a new grant-funded project. No existing information can be SUMMARY: Titles: a. PACT ‘‘Telehealth in the Parkinson’s Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home?’’, VA Form 10–0533. b. Geriatric Depression Scale (GDS) Short Form, VA Form 10–5033a. c. Quality of Life in Parkinson’s Disease, VA Form 10–0533b. d. Cost and Patient Outcomes Questions, VA Form 10–0533c. OMB Control Number: 2900—New (VA Form 10–0533a–c). Type of Review: New data collection. Abstract: The data collected on VA Forms 10–0533a-c will be used to obtain data on the cost, clinical outcomes, and patient satisfaction associated with expanded access to PADRECC care through the use of telehealth. VA will use the information to assess whether or not the use of telehealth is feasible, costeffective, and clinically equivalent alternative to routine face-to-face care for patients with Parkinson’s disease. Affected Public: Individuals or households. Estimated Annual Burden: 116 burden hours. Estimated Average Burden per Respondent: 4.4 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 400. Estimated Number of Responses: 1,600. 50549 E:\FR\FM\21AUN1.SGM 21AUN1 50550 Federal Register / Vol. 77, No. 162 / Tuesday, August 21, 2012 / Notices used to adequately evaluate the VHA PACT, evaluate patient experiences with PACT over time, and inform improvements to the redesign and its newly implemented innovations. Affected Public: Individuals or households. Estimated Annual Burden: a. VA Form 10–0530—25 hours. b. VA Form 10–0530a—17 hours. c. VA Form 10–0530b—17 hours. Estimated Average Burden Per Respondent: a. VA Form 10–0530—3 minutes. b. VA Form 10–0530a—2 minutes. c. VA Form 10–0530b—2 minutes. Frequency of Response: One-time. Estimated Number of Respondents: a. VA Form 10–0530—500. b. VA Form 10–0530a—500. c. VA Form 10–0530b—500. Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20458 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-New (VA Form 10– 0529a–f)] 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 develop and evaluate a patientcentered model of care for OEF/OIF veterans with PTSD. 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 pmangrum on DSK3VPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 15:31 Aug 20, 2012 Jkt 226001 Executive Office Building, Room 10235, Washington, DC 20503, (202) 395–7316 or FAX (202) 395–6974. Please refer to ‘‘2900–New (VA Form 10–0529a–f). 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 (10–0529a–f).’’ SUPPLEMENTARY INFORMATION: Title: 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) 10– 0532a. c. Pain Outcomes Questionnaire (Clark, Gironda, & Young, 2003)10– 0532b. d. The Multidimensional Pain Inventory (MPI; Kearns, Turk, & Rudy, 1985) 10–0532b. e. Pain Catastrophizing Scale (Osman, Barrios, Gutierrez, Kopper, Merrifield, & Grittmann, 2000) 10–0532d. f. The Oswestry Disability Index (Fairbank & Pynsent, 2000) 10–0532e. g. Brief Pain Inventory—Short Form (BPI; Cleeland, 1991). Administered at baseline and each follow-up. 10–0532f. h. Fear-Avoidance Beliefs Questionnaire (FABQ; Waddell, Newton, et al., 1993) 10–0532g. i. The Brief COPE (Carver, 1997) 10– 0532h. j. Depression and Anxiety Stress Scales (DASS–21; Lovibond & Lovibond, 1995) 10–0532i. k. Patient Health Questionnaire (PHQ–9; Kroenke, Spitzer, & Williams, 2001) 10–0532j. l. Generalized Anxiety Disorder (GAD–7); Spitzer, Kroenke, Williams, & Lowe, 2006) 10–0532k. OMB Control Number: 2900-New. Type of Review: New data collection. Abstract: The data collected on VA Forms 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 PO 00000 Frm 00094 Fmt 4703 Sfmt 9990 the effectiveness of the intervention so that it can most effectively be applied to future patients with chronic pain problems. Affected Public: Individuals or households. Estimated Annual Burden: a. VA Form 10–0532—67 hours. b. 10–0532A—80 hours. c. 10–0532B—200 hours. d. 10–0532C—80 hours. e. 10–0532D—53 hours. f. 10–0532E—53 hours. g. 10–0532F—133 hours. h. 10–0532G—19 hours. i. 10–0532H—27 hours. j. 10–0532I—93 hours. k. 10–0532J—67 hours. l. 20–0532K—67 hours. Estimated Average Burden per Respondent: a. VA Form 10–0532—5 minutes. b. 10–0532A—10 minutes. c. 10–0532B—15 minutes. d. 10–0532C—15 minutes. e. 10–0532D—10 minutes. f. 10–0532E—10 minutes. g. 10–0532F—10 minutes. h. 10–0532G—7 minutes. i. 10–0532H—10 minutes. j. 10–0532I—7 minutes. k. 10–0532J—5 minutes. l. 20–0532K—5 minutes. Frequency of Response: Monthly. Estimated Number of Respondents: a. VA Form 10–0532—800. b. 10–0532A—480. c. 10–0532B—800. d. 10–0532C—320. e. 10–0532D—320. f. 10–0532E—320. g. 10–0532F—800. h. 10–0532G—160. i. 10–0532H—160. j. 10–0532I—800. k. 10–0532J—800. l. 20–0532K—800. Dated: August 16, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20459 Filed 8–20–12; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\21AUN1.SGM 21AUN1

Agencies

[Federal Register Volume 77, Number 162 (Tuesday, August 21, 2012)]
[Notices]
[Pages 50549-50550]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-20458]


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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900--New (VA Form (10-0530a-b)]


Agency Information Collection: Emergency Submission for OMB 
Review (VISN 23 PACT Demonstration Lab: Patient Care Preferences 
Surveys); 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 improve health care for 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 10-0530a-b).

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 (10-0530a-b).

SUPPLEMENTARY INFORMATION: 
    Title: VISN 23 PACT Demonstration Lab: Patient Care Preferences 
Survey.
    a. Multidimensional Health Locus of Control, VA Form 10-0530.
    b. General Adherence Scale, VA Form 10-0530a.
    c. Demographic Data: Patient Background Information, VA Form 10-
0530b.
    OMB Control Number: 2900-New.
    Type of Review: New data collection.
    Abstract: This patient self-assessment of health study and patient 
satisfaction questionnaire seek to collect individual, primary data 
from patients concerning attitudes toward healthcare. The VHA PACT Demo 
Lab is a new grant-funded project. No existing information can be

[[Page 50550]]

used to adequately evaluate the VHA PACT, evaluate patient experiences 
with PACT over time, and inform improvements to the redesign and its 
newly implemented innovations.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-0530--25 hours.
    b. VA Form 10-0530a--17 hours.
    c. VA Form 10-0530b--17 hours.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-0530--3 minutes.
    b. VA Form 10-0530a--2 minutes.
    c. VA Form 10-0530b--2 minutes.
    Frequency of Response: One-time.
    Estimated Number of Respondents:
    a. VA Form 10-0530--500.
    b. VA Form 10-0530a--500.
    c. VA Form 10-0530b--500.

    Dated: August 16, 2012.

    By direction of the Secretary.
Denise McLamb,
 Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20458 Filed 8-20-12; 8:45 am]
BILLING CODE 8320-01-P
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