Agency Information Collection (Application for Extended Care Services, VA Form 10-10EC); Activity: Under OMB Review, 53115 [2014-21151]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 79, Number 172 (Friday, September 5, 2014)]
[Notices]
[Page 53115]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-21151]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0629]


Agency Information Collection (Application for Extended Care 
Services, VA Form 10-10EC); Activity: Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Health 
Administration (VHA), Department of Veterans Affairs, will submit the 
collection of information abstracted below to the Office of Management 
and Budget (OMB) for review and comment. The PRA submission describes 
the nature of the information collection and its expected cost and 
burden and includes the actual data collection instrument.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 6, 2014.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
oirasubmission@omb.eop.gov. Please refer to ``OMB Control No. 
2900-0629'' in any correspondence. During the comment period, comments 
may be viewed online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
crystal.rennie@va.gov. Please refer to ``OMB Control No. 2900-0629'' in 
any correspondence.

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, 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 currently 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. 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: September 2, 2014.

By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2014-21151 Filed 9-4-14; 8:45 am]
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