Proposed Information Collection (Disability Benefits Questionnaire (Group 4)) Activity: Comment Request, 8128-8129 [2016-03206]
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8128
Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices
Affected Public: State, local, or tribal
governments.
Estimated Total Annual Burden
Hours: 6,864.
DEPARTMENT OF THE TREASURY
Submission for OMB Review;
Comment Request
February 11, 2016.
asabaliauskas on DSK5VPTVN1PROD with NOTICES
The Department of the Treasury will
submit the following information
collection request to the Office of
Management and Budget (OMB) for
review and clearance in accordance
with the Paperwork Reduction Act of
1995, Public Law 104–13, on or after the
date of publication of this notice.
DATES: Comments should be received on
or before March 18, 2016 to be assured
of consideration.
ADDRESSES: Send comments regarding
the burden estimate, or any other aspect
of the information collection, including
suggestions for reducing the burden, to
(1) Office of Information and Regulatory
Affairs, Office of Management and
Budget, Attention: Desk Officer for
Treasury, New Executive Office
Building, Room 10235, Washington, DC
20503, or email at OIRA_Submission@
OMB.EOP.gov and (2) Treasury PRA
Clearance Officer, 1750 Pennsylvania
Ave. NW., Suite 8117, Washington, DC
20220, or email at PRA@treasury.gov.
FOR FURTHER INFORMATION CONTACT:
Copies of the submissions may be
obtained by emailing PRA@treasury.gov,
calling (202) 622–1295, or viewing the
entire information collection request at
www.reginfo.gov.
Departmental Offices
OMB Control Number: 1505–0250.
Type of Review: Reinstatement
without change of a previously
approved collection.
Title: Application and Reports for the
Direct Component and the Centers of
Excellence Research Grants Program of
the Gulf RESTORE Program.
Abstract: Authorized under the
Resources and Ecosystems
Sustainability, Tourist Opportunities,
and Revived Economies of the Gulf
Coast States Act (RESTORE) (P.L. 112–
141), the Department of the Treasury is
implementing several provisions of the
Act, more specifically the Direct
Component and the Centers of
Excellence Research Grants Program.
These programs require Treasury to
make grants from the Gulf Coast
Restoration Trust Fund to five States
and certain counties and parishes
impacted by the Deepwater Horizon Oil
Spill. The information collection will be
used to identify eligible recipients;
determine the appropriate amount of
funding; ensure compliance with
applicable laws; track grantee progress,
and report on the effectiveness of the
program.
VerDate Sep<11>2014
19:05 Feb 16, 2016
Jkt 238001
Brenda Simms,
Treasury PRA Clearance Officer.
[FR Doc. 2016–03209 Filed 2–16–16; 8:45 am]
BILLING CODE 4810–25–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0781]
Proposed Information Collection
(Disability Benefits Questionnaire
(Group 4)) Activity: Comment Request
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
The Veterans Benefits
Administration (VBA), 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.
The VA Form 21–0960 series 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. The Disability
Benefit Questionnaire title will include
the name of the specific disability for
which it will gather information. VAF
21–0960C–3, Cranial Nerve Conditions
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any cranial
nerve condition; VAF 21–0960C–6,
Narcolepsy Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
narcolepsy; VAF 21–0960C–7,
Fibromyalgia Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
fibromyalgia; VAF 21–0960C–11,
Seizure Disorders (Epilepsy) Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any seizure disorder
including epilepsy; VAF 21–0960D–1,
Oral and Dental Conditions Including
Mouth, Lips and Tongue (Other than
SUMMARY:
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Fmt 4703
Sfmt 4703
Temporomandibular Joint Conditions)
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any oral or
dental conditions; VAF 21–0960E–2,
Endocrine Diseases (Other Than
Thyroid, Parathyroid, or Diabetes
Mellitus) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any endocrine disease including
cushings and acromegaly however,
excluding diabetes; VAF 21–0960E–3,
Thyroid & Parathyroid Conditions
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any thyroid or
parathyroid condition; VAF 21–0960H–
1, Hernias (Including Abdominal,
Inguinal, and Femoral Hernias)
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of abdominal,
inguinal, or femoral hernias; VAF 21–
0960I–2, HIV-Related Illness Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any HIV-related illness;
VAF 21–0960I–3, Infectious Diseases
Other Than HIV-Related Illness,
Chronic Fatigue Syndrome, and
Tuberculosis Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any infectious diseases; VAF 21–0960I–
4, Systemic Lupus Erythematosus (SLE)
and Other Autoimmune Diseases
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of lupus or other
immune disorders; VAF 21–0960I–5,
Nutritional Deficiencies Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of nutritional deficiencies;
VAF 21–0960J–4, Urinary Tract
(including Bladder & Urethra)
Conditions (excluding Male
Reproductive System) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any urinary tract or bladder condition;
VAF 21–0960L–1, Respiratory
Conditions (Other than Tuberculosis &
Sleep Apnea) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any respiratory condition; VAF 21–
0960N–3, Loss of Sense of Smell and/or
Taste Disability Benefits Questionnaire,
will gather information related to the
claimant’s loss of sense of smell and
taste; VAF 21–0960N–4, Sinusitis/
Rhinitis and Other Conditions of the
Nose, Throat, Larynx, and Pharynx
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of sinusitis/rhinitis
E:\FR\FM\17FEN1.SGM
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Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices
or other diseases of the nose, throat,
larynx, or pharynx; VAF 21–0960Q–1,
Chronic Fatigue Syndrome Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of chronic fatigue syndrome.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before April 18, 2016.
ADDRESSES: Submit written comments
on the collection of information through
Federal Docket Management System
(FDMS) at www.Regulations.gov or to
Nancy J. Kessinger, Veterans Benefits
Administration (20M33), Department of
Veterans Affairs, 810 Vermont Avenue
NW., Washington, DC 20420 or email to
nancy.kessinger@va.gov. Please refer to
‘‘OMB Control No. 2900–0781’’ in any
correspondence.
asabaliauskas on DSK5VPTVN1PROD with NOTICES
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.
3501–21), 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, 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: Disability Benefits
Questionnaires (Group 4).
OMB Control Number: 2900–0781.
Type of Review: Revision of a
currently approved collection.
Abstract: The VA Form 21–0960
series 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.
Affected Public: Individuals or
households.
Estimated Annual Burden: 53,750.
VerDate Sep<11>2014
19:05 Feb 16, 2016
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Estimated Average Burden per
Respondent
i. VAF 21–0960C–3—30 minutes
ii. VAF 21–0960C–6—15 minutes
iii. VAF 21–0960C–7—15 minutes
iv. VAF 21–0960C–11—15 minutes
v. VAF 21–0960D–1—15 minutes
vi. VAF 21–0960E–2—15 minutes
vii. VAF 21–0960E–3—15 minutes
viii. VAF 21–0960H–1—15 minutes
ix. VAF 21–0960I–2—15 minutes
x. VAF 21–0960I–3—15 minutes
xi. VAF 21–0960I–4—30 minutes
xii. VAF 21–0960I–5—15 minutes
xiii. VAF 21–0960J–4—15 minutes
xiv. VAF 21–0960L–1—30 minutes
xv. VAF 21–0960N–3—15 minutes
xvi. VAF 21–0960N–4—30 minutes
xvii. VAF 21–0960Q–1—15 minutes
Frequency of Response: One time.
Estimated Number of Respondents:
160,000.
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. 2016–03206 Filed 2–16–16; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0778]
Proposed Information Collection
(Disability Benefits Questionnaire
(Group 3)); Activity: Comment Request
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
The Veterans Benefits
Administration (VBA), 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.
The VA Form 21–0960 series 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. The DBQ title
will include the name of the specific
disability for which it will gather
SUMMARY:
PO 00000
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Fmt 4703
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8129
information. VAF 21–0960C–5, Central
Nervous System and Neuromusculo
Diseases Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of a
central nervous system disease; VAF
21–0960C–8, Headaches (Including
Migraine Headaches) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
headaches; VAF 21–0960C–9, Multiple
Sclerosis (MS) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
multiple sclerosis; VAF 21–0960G–1,
Esophageal Disorders (including GERD,
Hiatal Hernia, and Other Esophageal
Disorders) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any esophageal disorders; VAF 21–
0960G–2, Gall Bladder and Pancreas
Conditions Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any gall bladder and pancreas
condition; VAF 21–0960G–3, Intestinal
Conditions (Other than Surgical or
Infectious) Including Irritable Bowel
Syndrome, Crohn’s Disease, Ulcerative
Colitis, and Diverticulitis Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any intestinal conditions
unrelated to surgery or infection; VAF
21–0960G–4, Infectious Intestinal
Disorders (including Bacterial and
Parasitic Infections) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any infectious intestinal condition; VAF
21–0960G–5, Hepatitis, Cirrhosis and
other Liver Conditions Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any liver condition; VAF
21–0960G–6, Peritoneal Adhesions
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of peritoneal
adhesions; VAF 21–0960G–7, Stomach
and Duodenum Conditions (Not
Including GERD or Esophageal
Disorders) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any stomach or duodenum conditions;
VAF 21–0960G–8, Intestinal Surgery
(Bowel Resection, Colostomy,
Ileostomy) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
any surgical intestinal condition; VAF
21–0960H–2, Rectum and Anus
Conditions (Including Hemorrhoids)
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any rectum or
E:\FR\FM\17FEN1.SGM
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]]>Agencies
[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)]
[Notices]
[Pages 8128-8129]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03206]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0781]
Proposed Information Collection (Disability Benefits
Questionnaire (Group 4)) Activity: Comment Request
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Veterans Benefits Administration (VBA), 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.
The VA Form 21-0960 series 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. The Disability Benefit Questionnaire title will
include the name of the specific disability for which it will gather
information. VAF 21-0960C-3, Cranial Nerve Conditions Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any cranial nerve condition; VAF 21-0960C-6,
Narcolepsy Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of narcolepsy; VAF 21-0960C-7,
Fibromyalgia Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of fibromyalgia; VAF 21-0960C-11,
Seizure Disorders (Epilepsy) Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any seizure
disorder including epilepsy; VAF 21-0960D-1, Oral and Dental Conditions
Including Mouth, Lips and Tongue (Other than Temporomandibular Joint
Conditions) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any oral or dental conditions;
VAF 21-0960E-2, Endocrine Diseases (Other Than Thyroid, Parathyroid, or
Diabetes Mellitus) Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of any endocrine
disease including cushings and acromegaly however, excluding diabetes;
VAF 21-0960E-3, Thyroid & Parathyroid Conditions Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any thyroid or parathyroid condition; VAF 21-0960H-1,
Hernias (Including Abdominal, Inguinal, and Femoral Hernias) Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of abdominal, inguinal, or femoral hernias; VAF
21-0960I-2, HIV-Related Illness Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any HIV-
related illness; VAF 21-0960I-3, Infectious Diseases Other Than HIV-
Related Illness, Chronic Fatigue Syndrome, and Tuberculosis Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any infectious diseases; VAF 21-0960I-4,
Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of lupus or other immune disorders; VAF 21-
0960I-5, Nutritional Deficiencies Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of
nutritional deficiencies; VAF 21-0960J-4, Urinary Tract (including
Bladder & Urethra) Conditions (excluding Male Reproductive System)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any urinary tract or bladder condition; VAF
21-0960L-1, Respiratory Conditions (Other than Tuberculosis & Sleep
Apnea) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any respiratory condition; VAF
21-0960N-3, Loss of Sense of Smell and/or Taste Disability Benefits
Questionnaire, will gather information related to the claimant's loss
of sense of smell and taste; VAF 21-0960N-4, Sinusitis/Rhinitis and
Other Conditions of the Nose, Throat, Larynx, and Pharynx Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of sinusitis/rhinitis
[[Page 8129]]
or other diseases of the nose, throat, larynx, or pharynx; VAF 21-
0960Q-1, Chronic Fatigue Syndrome Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of chronic
fatigue syndrome.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before April 18, 2016.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at www.Regulations.gov
or to Nancy J. Kessinger, Veterans Benefits Administration (20M33),
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC
20420 or email to nancy.kessinger@va.gov. Please refer to ``OMB Control
No. 2900-0781'' in any correspondence.
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. 3501-21), 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, 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: Disability Benefits Questionnaires (Group 4).
OMB Control Number: 2900-0781.
Type of Review: Revision of a currently approved collection.
Abstract: The VA Form 21-0960 series 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.
Affected Public: Individuals or households.
Estimated Annual Burden: 53,750.
Estimated Average Burden per Respondent
i. VAF 21-0960C-3--30 minutes
ii. VAF 21-0960C-6--15 minutes
iii. VAF 21-0960C-7--15 minutes
iv. VAF 21-0960C-11--15 minutes
v. VAF 21-0960D-1--15 minutes
vi. VAF 21-0960E-2--15 minutes
vii. VAF 21-0960E-3--15 minutes
viii. VAF 21-0960H-1--15 minutes
ix. VAF 21-0960I-2--15 minutes
x. VAF 21-0960I-3--15 minutes
xi. VAF 21-0960I-4--30 minutes
xii. VAF 21-0960I-5--15 minutes
xiii. VAF 21-0960J-4--15 minutes
xiv. VAF 21-0960L-1--30 minutes
xv. VAF 21-0960N-3--15 minutes
xvi. VAF 21-0960N-4--30 minutes
xvii. VAF 21-0960Q-1--15 minutes
Frequency of Response: One time.
Estimated Number of Respondents: 160,000.
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. 2016-03206 Filed 2-16-16; 8:45 am]
BILLING CODE 8320-01-P
