Agency Information Collection Activity: Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet, 19312-19313 [2017-08438]

Download as PDF 19312 Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices 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, 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. mstockstill on DSK30JT082PROD with NOTICES Authority: Public Law 104–13; 44 U.S.C. 3501–21. Title: (Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire (VA Form 21–0960A–2), Hypertension Disability Benefits Questionnaire (VA Form 21–0960A–3), Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefits Questionnaire (VA Form 21–0960A–4), Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire (VA Form 21–0960C–4), Diabetes Mellitus Disability Benefits Questionnaire (VA Form 21–0960E–1), Scars/Disfigurement Disability Benefits Questionnaire (VA Form 21–0960F–1), Skin Diseases Disability Benefits Questionnaire (VA Form 21–0960F–2), Amputations Disability Benefits Questionnaire (VA Form 21–0960M–1), Muscles Injuries Disability Benefits Questionnaire (VA Form 21–0960M– 10), Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire (VA Form 21–0960M– 15), Eye Conditions Disability Benefits Questionnaire (VA Form 21–0960N–2)). OMB Control Number: 2900–0776. Type of Review: Extension of an approved collection. Abstract: VA Form 21–0960 series is used to gather necessary information from a claimant’s treating physician regarding the results of medical VerDate Sep<11>2014 18:43 Apr 25, 2017 Jkt 241001 examinations. VA gathers 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 21–0960A–2, Artery and Vein Conditions vascular diseases including varicose veins) Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of arteries, veins, and/or peripheral vascular disease; VAF 21–0960A–3, Hypertension, Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of hypertension; VAF 21–0960A–4, Nonischemic Heart Disease (including Arrhythmias and Surgery) Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of any non-ischemic heart disease; VAF 21–0960C–4, Diabetic Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy) Disability Benefits Questionnaire will gather information related to the claimant’s diagnosis of a diabetic sensory-motor peripheral neuropathy condition; VAF 21–0960E–1, Diabetes Mellitus Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of diabetes mellitus; VAF 21–0960F–1, Scars/Disfigurement Disability Benefits Questionnaire will gather information related to the claimant’s diagnosis of any scars or disfigurement; VAF 21– 0960F–2, Skin Diseases Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of any skin disease. VAF 21– 0960M–1 Amputations Disability Benefits Questionnaire, will gather information related to the claimant’s amputations; VAF 21–0960M–10 Muscle Injuries Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of a muscle injury disability. VAF 21– 0960M–15 Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of temporomandibular joint dysfunction or TMJ. VAF 21–0960N–2 Eye Conditions Disability Benefits Questionnaire will gather information related to the claimant’s diagnosis of an eye condition. Affected Public: Individuals or households. Estimated Annual Burden: 162,500. Estimated Average Burden per Respondent: 25 minutes. Frequency of Response: One time. Estimated Number of Respondents: 400,000. PO 00000 Frm 00116 Fmt 4703 Sfmt 4703 By direction of the Secretary. Cynthia Harvey-Pryor, Department Clearance Officer, Enterprise Records Service, Office of Quality and Compliance, Department of Veterans Affairs. [FR Doc. 2017–08440 Filed 4–25–17; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0720] Agency Information Collection Activity: Operation Enduring Freedom/ Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet Veterans Benefits Administration, Department of Veterans Affairs. AGENCY: ACTION: Notice. 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 Form 21–0773 is a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness. This form will be maintained in the veteran’s claims folder. SUMMARY: Written comments and recommendations on the proposed collection of information should be received on or before June 26, 2017. DATES: 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. 2900–0720 ’’ in any correspondence. During the comment period, comments may be viewed online through the FDMS. ADDRESSES: E:\FR\FM\26APN1.SGM 26APN1 Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices mstockstill on DSK30JT082PROD 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, 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. Authority: Public Law 104–13; 44 U.S.C. 3501–21. Title: Operation Enduring Freedom/ Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet (VA Form 21–0773). OMB Control Number: 2900–0720. Type of Review: Revision of an approved collection. Abstract: VA Form 21–0773 is a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness. This form will be maintained in the veteran’s claims folder. Affected Public: Individuals or households. Estimated Annual Burden: 7,000 hours. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: One time. Estimated Number of Respondents: 14,000. By direction of the Secretary. Cynthia Harvey-Pryor, Department Clearance Officer, Enterprise Records Service, Office of Quality and Compliance, Department of Veterans Affairs. [FR Doc. 2017–08438 Filed 4–25–17; 8:45 am] BILLING CODE 8320–01–P VerDate Sep<11>2014 18:43 Apr 25, 2017 Jkt 241001 DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0091] Agency Information Collection Activity Under OMB Review: Application and Renewal for Health Care Benefits Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 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; it includes the actual data collection instrument. DATES: Comments must be submitted on or before May 26, 2017. 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. 2900–0091’’ in any correspondence. FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise Records Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461–5870 or email cynthia.harveypryor@va.gov. Please refer to ‘‘OMB Control No. 2900–0091.’’ SUPPLEMENTARY INFORMATION: SUMMARY: Authority: 44 U.S.C. 3501–3521. Titles: 1. Enrollment Application for VA Health Care—VA Form 10–10EZ. 2. Application for Renewal of Health Care Benefits—VA Form 10–10EZR. 3. Request for Hardship Determination—VA Form 10–10HS. OMB Control Number: 2900–0091. Type of Review: Reinstatement. Abstracts: a. VA Form 10–10EZ collects information only from new applicants for VA medical care, nursing home, domiciliary, dental benefits, and new enrollees in the VA health care system. b. VA Form 10–10EZR, Health Benefits Renewal Form, is used to collect data from those veterans who wish to update their application data. PO 00000 Frm 00117 Fmt 4703 Sfmt 9990 19313 c. VA Form 10–10HS collects information only from veterans who are in a copay required status for hospital care and medical services, but due to a loss of income project their income for the current year will be substantially below the VA means test limits. An agency may not conduct or sponsor, and a person is not required to 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 on February 1, January 19, 2017, Volume 82, No. 20, page 8971. Affected Public: Individuals or households. Estimated Annual Burden: a. Enrollment Application for VA Health Care—VA Form 10–10EZ— 270,000 hours. b. Application for Renewal of Health Care Benefits—VA Form 10–10EZR— 343,600 hours. c. Request for Hardship Determination—VA Form 10–10HS— 1,750 hours. Estimated Average Burden per Respondent: a. Enrollment Application for VA Health Care—VA Form 10–10EZ—30 minutes. b. Application for Renewal of Health Care Benefits—VA Form 10–10EZR—24 minutes. c. Request for Hardship Determination—VA Form 10–10HS—15 minutes. Frequency of Response: Annually. Estimated Annual Responses: a. Enrollment Application for VA Health Care—VA Form 10–10EZ— 540,000. b. Application for Renewal of Health Care Benefits—VA Form 10–10EZR— 859,000. c. Request for Hardship Determination—VA Form 10–10HS— 7,000. By direction of the Secretary. Cynthia Harvey-Pryor, Department Clearance Officer, Enterprise Records Service, Office of Quality and Compliance, Department of Veterans Affairs. [FR Doc. 2017–08441 Filed 4–25–17; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\26APN1.SGM 26APN1

Agencies

[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Pages 19312-19313]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-08438]


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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0720]


Agency Information Collection Activity: Operation Enduring 
Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member 
Veteran Worksheet

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. VA Form 21-0773 is a checklist for Veterans 
Service Representatives to verify they have given information, 
applications, and/or referral service to our Operation Enduring Freedom 
or Operation Iraqi Freedom service members who have at least six months 
remaining on active duty and who may have suffered a serious injury or 
illness. This form will be maintained in the veteran's claims folder.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before June 26, 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. 2900-0720 '' in any correspondence. During the comment period, 
comments may be viewed online through the FDMS.

[[Page 19313]]


FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 
or FAX (202) 632-8925.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995, 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.
    Authority: Public Law 104-13; 44 U.S.C. 3501-21.
    Title: Operation Enduring Freedom/Operation Iraqi Freedom Seriously 
Injured/Ill Service Member Veteran Worksheet (VA Form 21-0773).
    OMB Control Number: 2900-0720.
    Type of Review: Revision of an approved collection.
    Abstract: VA Form 21-0773 is a checklist for Veterans Service 
Representatives to verify they have given information, applications, 
and/or referral service to our Operation Enduring Freedom or Operation 
Iraqi Freedom service members who have at least six months remaining on 
active duty and who may have suffered a serious injury or illness. This 
form will be maintained in the veteran's claims folder.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 7,000 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 14,000.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of 
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-08438 Filed 4-25-17; 8:45 am]
 BILLING CODE 8320-01-P