Proposed Information Collection: Application for Extended Care Services, VA Form 10-10EC Activity: Comment Request, 33809 [2014-13728]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 79, Number 113 (Thursday, June 12, 2014)]
[Notices]
[Page 33809]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-13728]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0629]


Proposed Information Collection: Application for Extended Care 
Services, VA Form 10-10EC Activity: Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA) 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 revised collection, and allow 60 days for public comment 
in response to the notice. This notice solicits comments on information 
needed to obtain an accurate and comprehensive assessment of 
satisfaction of patients who receive mental health care services and on 
outcomes for Veterans who seek mental health treatment from VHA. Data 
will allow the program office to ensure that the target audience is 
being reached, effective treatments are being offered, and tangible, 
quantitative results are being measured and tracked for continual 
program improvement.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before August 11, 2014.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to Audrey Revere, Office of Regulatory and 
Administrative Affairs, Veterans Health Administration (10B4), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420 or email: Audrey.revere@va.gov. Please refer to ``OMB Control No. 
2900-0629, Application for Extended Care Services, VA Form 10-10EC'' in 
any correspondence. During the comment period, comments may be viewed 
online through FDMS.

FOR FURTHER INFORMATION CONTACT: Audrey Revere at (202) 461-5694.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), Federal agencies must obtain approval from 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.
    Title: Application for Extended Care Services, VA Form 10-10EC.
    OMB Control Number: 2900-0629.
    Type of Review: Revision of a previously approved collection.
    Abstract: Title 38 U.S.C. Chapter 17 authorizes VA to provide 
hospital care, medical services, domiciliary care and nursing home care 
to eligible Veterans. Title 38 U.S.C. Sec.  1705 requires VA to design, 
establish and operate a system of annual patient enrollment in 
accordance with a series of stipulated priorities. A consequence of 
this is that many groups of Veterans who are in a lower priority group 
may request that they be allowed to be income tested in order to gain a 
higher priority. Title 38 U.S.C. 1722 establishes eligibility 
assessment procedures for cost-free VA medical care, based on income 
levels, which will determine whether nonservice-connected and 0% 
service-connected noncompensable Veterans are able to defray the 
necessary expenses of care for nonservice-connected conditions. Title 
38 U.S.C. 1722A establishes the eligibility assessment procedures, 
based on income levels, for determining Veterans' eligibility for cost-
free medications and Title 38 U.S.C. 1710B defines the procedures for 
establishing eligibility for cost-free Extended Care benefits. Title 38 
U.S.C 1729 authorizes VA to recover from Veterans' health insurance 
carriers the cost of care furnished for their nonservice-connected 
conditions
    VA Form 10-10EC, Application for Extended Care Services, is used to 
collect financial information necessary to determine a Veteran's 
copayment obligation for extended care services, also known as long 
term care (LTC). VA Form 10-10EC, Application for Extended Care 
Services, collects information to establish eligibility for extended 
care benefits, establishes financial liability Veteran to pay if 
accepted for placement in Extended Care Services, and establishes 
veteran has agreed to make any applicable copayment.
    Affected Public: Individuals or Households
    Estimated Total Annual Burden: 3,000 hours.
    Estimated Average Burden per Respondent: 90 minutes
    Frequency of Response: Yearly
    Estimated Number of Respondents: 2,000.

    Dated: June 9, 2014.

    By direction of the Secretary.
Crystal Rennie,
Department Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2014-13728 Filed 6-11-14; 8:45 am]
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