Proposed Information Collection (Foreign Medical Program Application and Claim Cover Sheet) Activity: Comment Request, 46104-46105 [2015-18925]

Download as PDF 46104 Federal Register / Vol. 80, No. 148 / Monday, August 3, 2015 / Notices 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: Direct Deposit Enrollment; International Direct Deposit Enrollment (24–0296 & 24–0296a). OMB Control Number: 2900–0564. Type of Review: Revision of a currently approved collection. Abstract: The information collected on these forms will be used to enroll VA benefit recipients in the electronic funds transfer (EFT) program. Estimated Annual Burden: 1,250 hours. Estimated Average Burden per Respondent: 15 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 5,000. By direction of the Secretary. Kathleen M. Manwell, Program Analyst, VA Privacy Service, Office of Privacy and Records Management, Department of Veterans Affairs. [FR Doc. 2015–18924 Filed 7–31–15; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0648] Proposed Information Collection (Foreign Medical Program Application and Claim Cover Sheet) Activity: Comment Request Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. mstockstill on DSK4VPTVN1PROD with NOTICES AGENCY: The Veterans Health Administration (VHA) is announcing an opportunity for public comment on the proposed collection of certain SUMMARY: VerDate Sep<11>2014 18:35 Jul 31, 2015 Jkt 235001 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 extension of a currently approved collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on information needed to identify areas for improvement in clinical training programs. Written comments and recommendations on the proposed collection of information should be received on or before October 2, 2015. ADDRESSES: Submit written comments on the collection of information through the Federal Docket Management System (FDMS) at www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and Administrative Affairs, Veterans Health Administration (10B4), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email: Brian.McCarthy4@ va.gov. Please refer to ‘‘OMB Control No. 2900–0648’’ in any correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461–6345. 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. Titles: 1. Foreign Medical Program (FMP) Registration Form. 2. CLAIM COVER SHEET—FOREIGN MEDICAL PROGRAM (FMP). OMB Control Number: 2900–0648. Type of Review: Extension of a currently approved collection. DATES: PO 00000 Frm 00173 Fmt 4703 Sfmt 4703 Abstracts: This information collection is needed to carry out the health care benefits allowed by the Foreign Medical Program (FMP). It is a federal health benefits program for Veterans administered by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). FMP is a Fee for Service (indemnity plan) program. FMP provides reimbursement for VA adjudicated service-connected conditions. Title 38 CFR 17.35 states that the VA will provide coverage for the Veteran’s service-connected disability when the Veteran is residing or traveling overseas. VA Form 10–7959f–1, Foreign Medical Program (FMP) Registration Form, is used to register into the Foreign Medical Program those Veterans with service-connected disabilities that are living or traveling overseas. Title 38 CFR 17.125(d) states that requests for consideration of claim reimbursement from approved health care providers and Veterans are to be mailed to VHA Health Administration Center (HAC). The VA Form 10–7959f–2, Claim Cover Sheet—Foreign Medical Program streamlines the claims submission process for claimants or physicians while also reducing the time spent by VA on processing FMP claims. The cover sheet will allow foreign providers/ Veterans with a better understanding of basic information required for the processing and payment of claims. Affected Public: Individuals or households. Estimated Annual Burden: a. Foreign Medical Program (FMP) Registration Form—fill, VA Form 10– 7959f–1—111 hours. b. CLAIM COVER SHEET—FOREIGN MEDICAL PROGRAM (FMP)—fill, VA Form 10–7959f–2—3,652 hours. Estimated Average Burden per Respondent: a. Foreign Medical Program (FMP) Registration Form—fill, VA Form 10– 7959f–1—4 minutes. b. CLAIM COVER SHEET—FOREIGN MEDICAL PROGRAM (FMP)—fill, VA Form 10–7959f–2—11 minutes. Frequency of Response: a. Foreign Medical Program (FMP) Registration Form—fill, VA Form 10– 7959f–1—Annually b. CLAIM COVER SHEET—FOREIGN MEDICAL PROGRAM (FMP)—fill, VA Form 10–7959f–2 —12 times a year. Estimated Annual Responses: a. Foreign Medical Program (FMP) Registration Form—fill, VA Form 10– 7959f–1—1,660. b. CLAIM COVER SHEET—FOREIGN MEDICAL PROGRAM (FMP)—fill, VA Form 10–7959f–2—19,920. E:\FR\FM\03AUN1.SGM 03AUN1 Federal Register / Vol. 80, No. 148 / Monday, August 3, 2015 / Notices By direction of the Secretary. Kathleen M. Manwell, Program Analyst, VA Privacy Service, Office of Privacy and Records Management, Department of Veterans Affairs. [FR Doc. 2015–18925 Filed 7–31–15; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0784] Proposed Information Collection (NCA PreNeed Burial Planning) National Cemetery 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 National Cemetery Administration (NCA), 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; it includes the actual data collection instrument. DATES: Comments must be submitted on or before September 2, 2015. 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 oira_submission@ omb.eop.gov. Please refer to ‘‘OMB Control No. 2900–0784’’ in any correspondence. 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– 0784.’’ SUPPLEMENTARY INFORMATION: Title: NCA PreNeed Burial Eligibility Planning, VA Form 40–10007. OMB Control Number: 2900–0784. Type of Review: Revision of a currently approved collection. Abstract: VA Form Letter 40–10007 will be used to collect information from Veterans and service members with terminal illnesses and adult dependent children in hospitals and other institutions. An agency may not conduct or sponsor, and a person is not required to mstockstill on DSK4VPTVN1PROD with NOTICES SUMMARY: VerDate Sep<11>2014 18:35 Jul 31, 2015 Jkt 235001 respond to a collection of information unless it displays a currently valid OMB control number. The Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published at 80 FR 03446 on February 12, 2015. Affected Public: Individuals or households. Estimated Annual Burden: 2,000 hours. Estimated Average Burden per Respondent: 1 minute. Frequency of Response: One-time. Estimated Number of Respondents: 8,000. By direction of the Secretary. Kathleen M. Manwell, Program Analyst, VA Privacy Service, Office of Privacy and Records Management, Department of Veterans Affairs. [FR Doc. 2015–18930 Filed 7–31–15; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0090] Proposed Information Collection (Application for Voluntary Service VA Form 10–7055 and Associated Internet Application) ; Activity: 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 revised collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on the information needed for Veterans, Veteran Representatives and health care providers to request reimbursement from the federal government for emergency services at a private institution. SUMMARY: Written comments and recommendations on the proposed collection of information should be received on or before October 2, 2015. ADDRESSES: Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov; or DATES: PO 00000 Frm 00174 Fmt 4703 Sfmt 4703 46105 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. 2900–0090’’ in any correspondence. During the comment period, comments may be viewed online through the 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 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: Application for Voluntary Service VA Form 10–7055 and Associated Internet Application. OMB Control Number: 2900–0090. Type of Review: Revision. Abstract: This application (VA Form 10–7055 and the associated web form) will be here-in-after referred to as the form. The form is used to assist personnel of volunteer organizations, which recruit volunteers from their membership, and the Department of Veterans Affairs (VA) in the selection, screening and placement of volunteers in the nationwide VA Voluntary Service program. The volunteer program supplements the medical care and treatment of veteran patients in all VA medical centers. This form is necessary to assist in determining the suitability and placement of potential volunteers. The information is collected under the authority of 38 U.S.C. 7405(a). Affected Public: Individuals or Households. Estimated Annual Burden: 8,000 burden hours. Estimated Average Burden per Respondent: 15 minutes. E:\FR\FM\03AUN1.SGM 03AUN1

Agencies

[Federal Register Volume 80, Number 148 (Monday, August 3, 2015)]
[Notices]
[Pages 46104-46105]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18925]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0648]


Proposed Information Collection (Foreign Medical Program 
Application and Claim Cover Sheet) Activity: Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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

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 extension of a currently approved collection, and allow 
60 days for public comment in response to the notice. This notice 
solicits comments on information needed to identify areas for 
improvement in clinical training programs.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 2, 2015.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and 
Administrative Affairs, Veterans Health Administration (10B4), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420 or email: Brian.McCarthy4@va.gov. Please refer to ``OMB Control 
No. 2900-0648'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461-6345.

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.
    Titles:
    1. Foreign Medical Program (FMP) Registration Form.
    2. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP).
    OMB Control Number: 2900-0648.
    Type of Review: Extension of a currently approved collection.
    Abstracts: This information collection is needed to carry out the 
health care benefits allowed by the Foreign Medical Program (FMP). It 
is a federal health benefits program for Veterans administered by the 
Department of Veterans Affairs (VA) Veterans Health Administration 
(VHA). FMP is a Fee for Service (indemnity plan) program. FMP provides 
reimbursement for VA adjudicated service-connected conditions. Title 38 
CFR 17.35 states that the VA will provide coverage for the Veteran's 
service-connected disability when the Veteran is residing or traveling 
overseas.
    VA Form 10-7959f-1, Foreign Medical Program (FMP) Registration 
Form, is used to register into the Foreign Medical Program those 
Veterans with service-connected disabilities that are living or 
traveling overseas. Title 38 CFR 17.125(d) states that requests for 
consideration of claim reimbursement from approved health care 
providers and Veterans are to be mailed to VHA Health Administration 
Center (HAC). The VA Form 10-7959f-2, Claim Cover Sheet--Foreign 
Medical Program streamlines the claims submission process for claimants 
or physicians while also reducing the time spent by VA on processing 
FMP claims. The cover sheet will allow foreign providers/Veterans with 
a better understanding of basic information required for the processing 
and payment of claims.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--111 hours.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--3,652 hours.
    Estimated Average Burden per Respondent:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--4 minutes.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--11 minutes.
    Frequency of Response:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--Annually
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2 --12 times a year.
    Estimated Annual Responses:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--1,660.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--19,920.


[[Page 46105]]


    By direction of the Secretary.
Kathleen M. Manwell,
Program Analyst, VA Privacy Service, Office of Privacy and Records 
Management, Department of Veterans Affairs.
[FR Doc. 2015-18925 Filed 7-31-15; 8:45 am]
BILLING CODE 8320-01-P
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