Proposed Information Collection (Application for CHAMPVA Benefits); Comment Request, 34709-34710 [2013-13693]
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mstockstill on DSK4VPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 111 / Monday, June 10, 2013 / Notices
Nancy J. Kessinger, Veterans Benefits
Administration (20M35), Department of
Veterans Affairs, 810 Vermont Avenue
NW., Washington, DC 20420 or email:
nancy.kessinger@va.gov. Please refer to
‘‘OMB Control No. 2900—NEW (Foot
(including flatfeet (pes planus))
Conditions Disability Benefits
Questionnaire)’’ in any correspondence.
During the comment period, comments
may be viewed online through the
FDMS.
FOR FURTHER INFORMATION CONTACT:
Nancy J. Kessinger at (202) 632–8924 or
Fax (202) 632–8925.
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, VBA invites
comments on: (1) Whether the proposed
collection of information is necessary
for the proper performance of VBA’s
functions, including whether the
information will have practical utility;
(2) the accuracy of VBA’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.
Title: (Foot (including flatfeet (pes
planus)) Conditions Disability Benefits
Questionnaire), VA Form 21–0960M–6.
OMB Control Number: 2900—NEW
(Foot (including flatfeet (pes planus))
Conditions Disability Benefits
Questionnaire).
Type of Review: New data collection.
Abstract: VA Form 21–0960M–6 will
be used to gather necessary information
from a claimant’s treating physician
regarding the results of medical
examinations. VA will gather medical
information related to the claimant that
is necessary to adjudicate the claim for
VA disability benefits. This form will
gather information related to the
claimants’ diagnosis of a foot condition.
Affected Public: Individuals or
Households.
Estimated Annual Burden: 20,000
hours.
Estimated Average Burden per
Respondent: 30 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
80,000.
VerDate Mar<15>2010
16:56 Jun 07, 2013
Jkt 229001
Dated: June 5, 2013.
By direction of the Secretary:
Crystal Rennie,
VA Clearance Officer, Enterprise Records
Service, Office of Information Security, Office
of Information and Technology, U.S.
Department of Veterans Affairs.
[FR Doc. 2013–13644 Filed 6–7–13; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0219]
Proposed Information Collection
(Application for CHAMPVA Benefits);
Comment Request
Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
The Veterans Health
Administration (VHA), Department of
Veterans Affairs (VA), 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
revision of a currently approved
collection, and allow 60 days for public
comment in response to the notice. This
notice solicits comments for information
needed for Health Administration
Center staff to adjudicate/pay healthcare
benefit claims.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before August 9, 2013.
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 (10B4), Department of
Veterans Affairs, 810 Vermont Avenue
NW., Washington, DC 20420 or email:
cynthia.harvey-pryor@va.gov. Please
refer to ‘‘OMB Control No. 2900–0219’’
in any correspondence. During the
comment period, comments may be
viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor at (202) 461–5870
or Fax (202) 495–5397.
SUPPLEMENTARY INFORMATION: Under the
PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
3501–21), Federal agencies must obtain
approval from the Office of Management
and Budget (OMB) for each collection of
information they conduct or sponsor.
SUMMARY:
PO 00000
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34709
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. Application for CHAMPVA
Benefits, VA Form 10–10d.
b. CHAMPVA Claim Form, VA Form
10–7959a.
c. CHAMPVA Other Health Insurance
(OHI) Certification, VA Form 10–7959c.
d. CHAMPVA Potential Liability
Claim, VA Form 10–7959d.
e. Claim for Miscellaneous Expenses,
VA Form 10–7959e.
OMB Control Number: 2900–0219.
Type of Review: Revision of a
currently approved collection.
Abstracts:
a. VA Form 10–10d is used to
determine eligibility of persons
applying for healthcare benefits under
the CHAMPVA program.
b. VA Form 10–7959a is used to
adjudicate claims for CHAMPVA
benefits in accordance with 30 U.S.C.
Sections 501 and 1781, and 10 U.S.C.
Sections 1079 and 1086.
c. VA Form 10–7959c is used to
systematically obtain other health
insurance information and to correctly
coordinate benefits among all liable
parties.
d. VA Form 10–7959d form provides
basic information from which potential
liability can be assessed.
e. Beneficiaries complete VA Form
10–7959e to carry out health care
programs for certain children of Korea
and/or Vietnam Veterans authorized
under 38, U.S.C., chapter 18, as
amended by section 401, Public Law
106–419 and section 102, Public Law
108–183.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. VA Form 10–10d—5,294 hours.
b. VA Form 10–7959a—22,402 hours.
c. VA Form 10–7959c—6,728 hours.
d. VA Form 10–7959d—467 hours.
e. VA Form 10–7959e—1500 hours.
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34710
Federal Register / Vol. 78, No. 111 / Monday, June 10, 2013 / Notices
mstockstill on DSK4VPTVN1PROD with NOTICES
Estimated Average Burden per
Respondent:
a. VA Form 10–10d—12 minutes.
b. VA Form 10–7959a—6 minutes.
c. VA Form 10–7959c—5 minutes.
d. VA Form 10–7959d—7 minutes.
e. VA Form 10–7959e—30 minutes.
Frequency of Response: On occasion.
VerDate Mar<15>2010
16:56 Jun 07, 2013
Jkt 229001
Estimated Number of Respondents:
a. VA Form 10–10d—26,468.
b. VA Form 10–7959a—224,018.
c. VA Form 10–7959c—80,733.
d. VA Form 10–7959d—4,000.
e. VA Form 10–7959e—3,000.
By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, Enterprise Records
Service, Office of Information Security, Office
of Information and Technology, U.S.
Department of Veterans Affairs.
Dated: June 5, 2013.
BILLING CODE 8320–01–P
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[FR Doc. 2013–13693 Filed 6–7–13; 8:45 am]
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]]>Agencies
[Federal Register Volume 78, Number 111 (Monday, June 10, 2013)]
[Notices]
[Pages 34709-34710]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-13693]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0219]
Proposed Information Collection (Application for CHAMPVA
Benefits); Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Veterans Health Administration (VHA), Department of
Veterans Affairs (VA), 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 revision of
a currently approved collection, and allow 60 days for public comment
in response to the notice. This notice solicits comments for
information needed for Health Administration Center staff to
adjudicate/pay healthcare benefit claims.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before August 9, 2013.
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 (10B4), Department of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420 or email: cynthia.harvey-pryor@va.gov.
Please refer to ``OMB Control No. 2900-0219'' in any correspondence.
During the comment period, comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-5870
or Fax (202) 495-5397.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C. 3501-21), 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. Application for CHAMPVA Benefits, VA Form 10-10d.
b. CHAMPVA Claim Form, VA Form 10-7959a.
c. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-
7959c.
d. CHAMPVA Potential Liability Claim, VA Form 10-7959d.
e. Claim for Miscellaneous Expenses, VA Form 10-7959e.
OMB Control Number: 2900-0219.
Type of Review: Revision of a currently approved collection.
Abstracts:
a. VA Form 10-10d is used to determine eligibility of persons
applying for healthcare benefits under the CHAMPVA program.
b. VA Form 10-7959a is used to adjudicate claims for CHAMPVA
benefits in accordance with 30 U.S.C. Sections 501 and 1781, and 10
U.S.C. Sections 1079 and 1086.
c. VA Form 10-7959c is used to systematically obtain other health
insurance information and to correctly coordinate benefits among all
liable parties.
d. VA Form 10-7959d form provides basic information from which
potential liability can be assessed.
e. Beneficiaries complete VA Form 10-7959e to carry out health care
programs for certain children of Korea and/or Vietnam Veterans
authorized under 38, U.S.C., chapter 18, as amended by section 401,
Public Law 106-419 and section 102, Public Law 108-183.
Affected Public: Individuals or households.
Estimated Annual Burden:
a. VA Form 10-10d--5,294 hours.
b. VA Form 10-7959a--22,402 hours.
c. VA Form 10-7959c--6,728 hours.
d. VA Form 10-7959d--467 hours.
e. VA Form 10-7959e--1500 hours.
[[Page 34710]]
Estimated Average Burden per Respondent:
a. VA Form 10-10d--12 minutes.
b. VA Form 10-7959a--6 minutes.
c. VA Form 10-7959c--5 minutes.
d. VA Form 10-7959d--7 minutes.
e. VA Form 10-7959e--30 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VA Form 10-10d--26,468.
b. VA Form 10-7959a--224,018.
c. VA Form 10-7959c--80,733.
d. VA Form 10-7959d--4,000.
e. VA Form 10-7959e--3,000.
Dated: June 5, 2013.
By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, Enterprise Records Service, Office of Information
Security, Office of Information and Technology, U.S. Department of
Veterans Affairs.
[FR Doc. 2013-13693 Filed 6-7-13; 8:45 am]
BILLING CODE 8320-01-P
