Agency Information Collection Activity: Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases Disability Benefits Questionnaire, Amputations Disability Benefits Questionnaire, Muscles Injuries Disability Benefits Questionnaire, Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire, Eye Conditions Disability Benefits Questionnaire, 19311-19312 [2017-08440]

Download as PDF mstockstill on DSK30JT082PROD with NOTICES Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices is to conduct a survey of Veterans to capture novel predictors of hospital admission and identify clusters of complex patients based on survey- and claims-based covariates. This study provides the first empirical application of the Cycle of Complexity conceptual model that the study team developed and recently published, which postulates that patient complexity represents more than having multiple chronic conditions. It is critical to evaluate whether complexity defined on the basis of survey-based and claimsbased covariates is more predictive than diagnosis of multiple chronic conditions based on claims data alone. The proposed patient survey is designed to measure a broad range of self-reported patient factors that increase Veterans’ risk for being admitted to hospital, including life stressors, perceived locus of control, grit, resilience, functional status, social support and loneliness, sleep problems, symptoms, food insecurity, and patient activation. This survey will help us understand, for the first time, the extent to which self-reported factors can markedly improve prediction of patient risk for hospital admission, which may help the PACT Demonstration Lab Coordinating Center Intelligence improve its risk prediction models. This project may also identify patientreported outcomes (PROs) that can be effectively integrated into routine VA clinical practice, as the VA begins to explore inclusion of PROs into the VA electronic health record. We are requesting approval to conduct this survey to a nationally representative sample of 10,000 patients who obtain primary care in VA because there are no extant VA surveys that capture the range of patient factors that we propose to collect, which are not available in VA administrative databases. If we did not capture these patient factors, our risk prediction analysis might be incorrect or biased. 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 Thursday, January 26, 2017, Volume 82, No. 16, pages 8563–8564. Affected Public: Individuals or households. Estimated Annual Burden: 2500. Estimated Average Burden per Respondent: 30 minutes. Frequency of Response: Annually. Estimated Annual Responses: 5,000. VerDate Sep<11>2014 18:43 Apr 25, 2017 Jkt 241001 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. 2017–08442 Filed 4–25–17; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0776] Agency Information Collection Activity: Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases Disability Benefits Questionnaire, Amputations Disability Benefits Questionnaire, Muscles Injuries Disability Benefits Questionnaire, Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire, Eye Conditions Disability Benefits Questionnaire 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 Form 21–0960 series is used to gather necessary information from a claimant’s treating physician regarding the results of medical 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 SUMMARY: PO 00000 Frm 00115 Fmt 4703 Sfmt 4703 19311 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, Non-ischemic Heart Disease (including Arrhythmias and Surgery) Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of any nonischemic 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. 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. 2900–0776’’ in any correspondence. During the comment ADDRESSES: E:\FR\FM\26APN1.SGM 26APN1 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

Agencies

[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Pages 19311-19312]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-08440]


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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0776]


Agency Information Collection Activity: Artery and Vein 
Conditions (Vascular Diseases Including Varicose Veins) Disability 
Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, 
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) 
Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy 
(Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits 
Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, 
Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases 
Disability Benefits Questionnaire, Amputations Disability Benefits 
Questionnaire, Muscles Injuries Disability Benefits Questionnaire, 
Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire, Eye Conditions Disability Benefits Questionnaire

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 21-0960 series is used to gather necessary information from 
a claimant's treating physician regarding the results of medical 
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, Non-ischemic 
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.

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. 2900-0776'' in any correspondence. During the comment

[[Page 19312]]

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.

    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 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, Non-ischemic 
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.

    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