Agency Information Collection: Emergency Submission for OMB Review (PACT: Clinical Innovation Study-Helping Veterans Manage Chronic Pain); Comment Request, 51850-51851 [2012-20917]

Download as PDF 51850 Federal Register / Vol. 77, No. 166 / Monday, August 27, 2012 / Notices OEF/OIF Veterans with PTSD: Bridging Primary and Behavioral Health Care. a. SF 12, Questionnaire, VA Form 10– 0529. b. (Patient Health Questionnaire-9 (PHQ–9), VA Form 10–0529a. c. PTSD Checklist (PCL), VA Form 10–0529Bb. d. Patient Satisfaction QuestionnaireShort Form (PSQ–18), VA Form 10– 0529c. e. Combat Exposure Scale (CES), VA Form 10–0529d. f. World Health Organization Quality of Life (WHOQOL–BREF), VA Form 10– 0529e. g. World Health Organization Disability Assessment Schedule II (WHODAS–II), VA Form 10–0529f. OMB Control Number: 2900-New. Type of Review: New data collection. The data collected on VA Forms 10– 0529a–f will be used to develop and evaluate a patient-centered model of care for OEF/OIF Veterans with PTSD. The forms will be used to survey the effectiveness of the patient centered medical home model by enhancing the conventional care currently provided in the care of patients with PTSD. Affected Public: Individuals or households. Estimated Annual Burden: 420. Frequency of Response: Annually. Estimated Average Burden per Respondent: 10 minutes. Estimated Number of Respondents: 840. Estimated Number of Responses: 2,520. Dated: August 21, 2012. By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20916 Filed 8–24–12; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-New (VA Form 10– 0532a–k)] pmangrum on DSK3VPTVN1PROD with NOTICES 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 SUMMARY: VerDate Mar<15>2010 15:04 Aug 24, 2012 Jkt 226001 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 September 6, 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 10–0532a–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 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 PO 00000 Frm 00103 Fmt 4703 Sfmt 4703 (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 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 pain 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. 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. E:\FR\FM\27AUN1.SGM 27AUN1 Federal Register / Vol. 77, No. 166 / Monday, August 27, 2012 / Notices 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 21, 2012. 51851 By direction of the Secretary. Denise McLamb, Program Analyst Director, Enterprise Records Service. [FR Doc. 2012–20917 Filed 8–24–12; 8:45 am] pmangrum on DSK3VPTVN1PROD with NOTICES BILLING CODE 8320–01–P VerDate Mar<15>2010 15:04 Aug 24, 2012 Jkt 226001 PO 00000 Frm 00104 Fmt 4703 Sfmt 9990 E:\FR\FM\27AUN1.SGM 27AUN1

Agencies

[Federal Register Volume 77, Number 166 (Monday, August 27, 2012)]
[Notices]
[Pages 51850-51851]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-20917]


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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New (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 September 6, 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 10-0532a-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 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 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 pain 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.
    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.

[[Page 51851]]

    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 21, 2012.

    By direction of the Secretary.
Denise McLamb,
Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20917 Filed 8-24-12; 8:45 am]
BILLING CODE 8320-01-P
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