Agency Information Collection Activity: (Application and Training Agreement for Apprenticeship and On-the-Job Training Programs) (VA Form 22-8864; 22-8865)), 8567-8568 [2017-01748]

Download as PDF jstallworth on DSK7TPTVN1PROD with NOTICES Federal Register / Vol. 82, No. 16 / Thursday, January 26, 2017 / Notices Veteran to verify the listed income on the form as reported to IVD by IRS/SSA, to select the appropriate option on the form relating to the household income, attest to out of pocket medical expenses, attest to sale of primary home real estate and attest to separation from spouse for the income year under the Income Verification Division’s review. The Veteran’s signature is required on page 2 of HEC Form 200–1A. If the Veteran has medical/health limitations that does not enable the Veteran to physically sign the form with a wet signature, the Veteran must mark an ‘‘X’’ to designate a signature; two witnesses must verify the ‘‘X’’ as the Veteran’s signature. HEC, IVD will use the completed HEC Form 200–1A to assist in verifying the Veteran’s correct gross household income to ensure the Veteran is placed in the correct priority group for health care. The HEC, IVD uses HEC Form 220–1 (Spouse’s Income Verification Response) to collect income verification information, as applicable, from the Veteran’s spouse by requesting the spouse to verify the listed income on the form as reported to IVD by IRS/SSA, report any additional income not reported by IRS/SSA and sign and date the form. If the spouse has medical/ health limitations that does not enable the spouse to physically sign the form with a wet signature, the spouse must mark an ‘‘X’’ to designate a signature; two witnesses must verify the ‘‘X’’ as the Veteran’s signature. HEC, IVD will use the completed HEC Form 220–1 to assist in verifying the Veteran’s correct gross household income to ensure the Veteran is placed in the correct priority group for health care. The HEC, IVD uses the HEC Form 340–1 (Declaration of Representative) for the Veteran and the spouse (if applicable) to appoint a representative, authorizing HEC, IVD to release information to a designated appointee for a specific income year. Such information includes confidential federal tax information, other income, and medical benefits eligibility related information. The Veteran and spouse (if applicable) must sign and date the form. The HEC, IVD uses the HEC Income Verification—Additional Information Checklist to request from the Veteran any additional information needed to adjudicate the Income Verification case. The Veteran providing the requested information usually results in the best interest to the Veteran. Affected Public: Individuals or households. Estimated Annual Burden: VerDate Sep<11>2014 15:10 Jan 25, 2017 Jkt 241001 a. Mailed with Veterans’ Initial Letters—HEC Form 200–1A—89,001 hours b. Mailed with Spouses’ Initial Letters—HEC Form 220–1—28,530 hours c. Mailed to Veterans When Necessary—HEC Form 340–1—1,701 hours d. Mailed to Veterans When Necessary—Checklist—761 hours Estimated Average Burden per Respondent: a. Mailed with Veterans’ Initial Letters—HEC Form 200–1A—30 minutes b. Mailed with Spouses’ Initial Letters—HEC Form 220–1—20 minutes c. Mailed to Veterans When Necessary—HEC Form 340–1—15 minutes d. Mailed to Veterans When Necessary—Checklist—761—15 minutes Frequency of Response: Annually. Estimated Annual Responses: a. Mailed with Veterans’ Initial Letters—HEC Form 200–1A—178,002 b. Mailed with Spouses’ Initial Letters—HEC Form 220–1—85,590 c. Mailed to Veterans When Necessary—HEC Form 340–1—6,805 d. Mailed to Veterans When Necessary—Checklist—761—3,044 By direction of the Secretary. Cynthia Harvey-Pryor, Program Specialist, Office of Privacy and Records Management, Department of Veterans Affairs. [FR Doc. 2017–01753 Filed 1–25–17; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0342] Agency Information Collection Activity: (Application and Training Agreement for Apprenticeship and Onthe-Job Training Programs) (VA Form 22–8864; 22–8865)) 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 SUMMARY: PO 00000 Frm 00065 Fmt 4703 Sfmt 4703 8567 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 determine that training programs (Apprenticeship and On-theJob Training) and agreements meet the statutory requirements for approval. DATES: Written comments and recommendations on the proposed collection of information should be received on or before March 27, 2017. 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. 2900–0342’’ 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. 3501–21), 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: Application and Training Agreement for Apprenticeship and Onthe-Job Training Programs, VA Form 22–8864; 22–8865. OMB Control Number: 2900–0342. Type of Review: Revision of a currently approved collection. Abstract: VA Forms 22–8864 and 22– 8865 are used to collect information from employers and trainees to ensure that training programs (Apprenticeship and On-the-Job Training) and E:\FR\FM\26JAN1.SGM 26JAN1 8568 Federal Register / Vol. 82, No. 16 / Thursday, January 26, 2017 / Notices period, comments may be viewed online through the FDMS. SUPPLEMENTARY INFORMATION: [FR Doc. 2017–01748 Filed 1–25–17; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0802] Agency Information Collection Activity: Shoulder and Arm Conditions Disability Benefits Questionnaire (VA Form 21–0960M–12) 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. VA Forms 21–0960M–12 is used to gather necessary information from a claimant’s treating physician regarding the results of medical examinations. DATES: Written comments and recommendations on the proposed collection of information should be received on or before March 27, 2017. 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. 2900–0802’’ in any correspondence. During the comment jstallworth on DSK7TPTVN1PROD with NOTICES VerDate Sep<11>2014 15:10 Jan 25, 2017 Jkt 241001 [OMB Control No. 2900–0576] Nancy J. Kessinger at (202) 632–8924 or FAX (202) 632–8925. By direction of the Secretary. Cynthia Harvey-Pryor, Agency Clearance Officer, Office of Privacy and Records Management, Department of Veterans Affairs. SUMMARY: DEPARTMENT OF VETERANS AFFAIRS FOR FURTHER INFORMATION CONTACT: agreements meet the statutory requirements for approval. Affected Public: Individuals or household or small businesses/other small entities. Estimated Annual Burden: 19,535 hours. Estimated Average Burden per Respondent: 75 minutes. Frequency of Response: Once. Estimated Number of Respondents: 15,628. Under the PRA of 1995 (Public Law 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: (Shoulder and Arm Conditions Disability Benefits Questionnaire (VA Form 21–0960M–12). OMB Control Number: 2900–0802. Type of Review: Extension of an approved collection. Abstract: VA Forms 21–0960M–12 is used to gather necessary information from a claimant’s treating physician regarding the results of medical examinations. Affected Public: Individuals or households. Estimated Annual Burden: 25,000 hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One time. Estimated Number of Respondents: 50,000 per year. By direction of the Secretary. Cynthia Harvey-Pryor, Department Clearance Officer, Office of Privacy and Records Management, Department of Veterans Affairs. [FR Doc. 2017–01751 Filed 1–25–17; 8:45 am] BILLING CODE 8320–01–P PO 00000 Frm 00066 Fmt 4703 Sfmt 4703 Agency Information Collection Activity: Certification of Affirmation of Enrollment Agreement Correspondence Course (VA Form 22– 1999c) 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. This notice solicits comments on information needed to determine a claimant’s entitlement to educational assistance. DATES: Written comments and recommendations on the proposed collection of information should be received on or before March 27, 2017. 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. 2900–0576’’ 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. 3501–21), 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; SUMMARY: E:\FR\FM\26JAN1.SGM 26JAN1

Agencies

[Federal Register Volume 82, Number 16 (Thursday, January 26, 2017)]
[Notices]
[Pages 8567-8568]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-01748]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0342]


Agency Information Collection Activity: (Application and Training 
Agreement for Apprenticeship and On-the-Job Training Programs) (VA Form 
22-8864; 22-8865))

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 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 determine that training programs (Apprenticeship 
and On-the-Job Training) and agreements meet the statutory requirements 
for approval.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before March 27, 2017.

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. 2900-0342'' 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. 3501-21), 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: Application and Training Agreement for Apprenticeship and 
On-the-Job Training Programs, VA Form 22-8864; 22-8865.
    OMB Control Number: 2900-0342.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA Forms 22-8864 and 22-8865 are used to collect 
information from employers and trainees to ensure that training 
programs (Apprenticeship and On-the-Job Training) and

[[Page 8568]]

agreements meet the statutory requirements for approval.
    Affected Public: Individuals or household or small businesses/other 
small entities.
    Estimated Annual Burden: 19,535 hours.
    Estimated Average Burden per Respondent: 75 minutes.
    Frequency of Response: Once.
    Estimated Number of Respondents: 15,628.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Agency Clearance Officer, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-01748 Filed 1-25-17; 8:45 am]
BILLING CODE 8320-01-P