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