Agency Information Collection Activity: Disability Benefits Questionnaire (Group 4), 19831-19832 [2019-09203]
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Federal Register / Vol. 84, No. 87 / Monday, May 6, 2019 / Notices
care personnel education and training
programs) mandates that VHA assist in
the training of health professionals for
its own needs and for those of the
nation.
The VA Form 10–2850D application
will collect information from health
professions trainees prior to VA
appointment. All health professions
trainees must provide information
concerning their background, training,
education, degrees, licensure,
registrations, and other vital information
to ensure appropriate qualifications for
VA assignment.
Affected Public: Individuals and
households.
Estimated Annual Burden: 60,500
hours.
Estimated Average Burden per
Respondent: 30 minutes.
Frequency of Response: Annually.
Estimated Number of Respondents:
121,000.
By direction of the Secretary.
Danny S. Green,
Interim VA Clearance Officer, Office of
Quality, Performance and Risk (OQPR),
Department of Veterans Affairs.
[FR Doc. 2019–09132 Filed 5–3–19; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0781]
Agency Information Collection
Activity: Disability Benefits
Questionnaire (Group 4)
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
Veterans Benefits
Administration, 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.
DATES: Written comments and
recommendations on the proposed
collection of information should be
received on or before July 5, 2019.
ADDRESSES: Submit written comments
on the collection of information through
Federal Docket Management System
(FDMS) at www.Regulations.gov or to
jbell on DSK3GLQ082PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
19:35 May 03, 2019
Jkt 247001
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. During the comment
period, comments may be viewed online
through FDMS.
FOR FURTHER INFORMATION CONTACT:
Danny S. Green at (202) 421–1354.
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. 3501–3521.
Title: Disability Benefits
Questionnaire (Group 4).
OMB Control Number: 2900–0781.
Type of Review: Extension 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. The
Disability Benefits Questionnaire title
will include the name of the specific
disability for which it will gather
information. The Disability Benefit
Questionnaire Group 4 includes the
following forms: VA Form 21–0960C–3,
Cranial Nerve Conditions Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any cranial nerve
condition; VA Form 21–0960C–6,
Narcolepsy Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
narcolepsy; VA Form 21–0960C–7,
Fibromyalgia Disability Benefits
PO 00000
Frm 00079
Fmt 4703
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19831
Questionnaire, will gather information
related to the claimant’s diagnosis of
fibromyalgia; VA Form 21–0960C–11,
Seizure Disorders (Epilepsy) Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any seizure disorder
including epilepsy; VA Form 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; VA Form
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 it
excludes diabetes; VA Form 21–0960E–
3, Thyroid and Parathyroid Conditions
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any thyroid or
parathyroid condition; VA Form 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;
VA Form 21–0960I–2, HIV-Related
Illness Disability Benefits Questionnaire,
will gather information related to the
claimant’s diagnosis of any HIV-related
illness; VA Form 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; VA Form 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; VA Form 21–0960I–
5, Nutritional Deficiencies Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of nutritional deficiencies; VA
Form 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;
VA Form 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; VA Form 21–
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19832
Federal Register / Vol. 84, No. 87 / Monday, May 6, 2019 / Notices
jbell on DSK3GLQ082PROD with NOTICES
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; VA Form 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
or other diseases of the nose, throat,
larynx, or pharynx; VA Form 21–
VerDate Sep<11>2014
19:35 May 03, 2019
Jkt 247001
0960Q–1, Chronic Fatigue Syndrome
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of chronic fatigue
syndrome.
Affected Public: Individuals and
households.
Estimated Annual Burden: 53,750
hours.
Estimated Average Burden per
Respondent: 18.5 minutes per form (17
forms).
PO 00000
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Frequency of Response: One-time.
Estimated Number of Respondents:
160,000.
By direction of the Secretary.
Danny S. Green,
VA Interim Clearance Officer, Office of
Quality, Performance and Risk, Department
of Veterans Affairs.
[FR Doc. 2019–09203 Filed 5–3–19; 8:45 am]
BILLING CODE 8320–01–P
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]]>Agencies
[Federal Register Volume 84, Number 87 (Monday, May 6, 2019)]
[Notices]
[Pages 19831-19832]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-09203]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0781]
Agency Information Collection Activity: Disability Benefits
Questionnaire (Group 4)
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: Veterans Benefits Administration, 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.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before July 5, 2019.
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 [email protected] Please refer to ``OMB Control
No. 2900-0781'' in any correspondence. During the comment period,
comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Danny S. Green at (202) 421-1354.
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. 3501-3521.
Title: Disability Benefits Questionnaire (Group 4).
OMB Control Number: 2900-0781.
Type of Review: Extension 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. The Disability Benefits Questionnaire title
will include the name of the specific disability for which it will
gather information. The Disability Benefit Questionnaire Group 4
includes the following forms: VA Form 21-0960C-3, Cranial Nerve
Conditions Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any cranial nerve condition; VA
Form 21-0960C-6, Narcolepsy Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of narcolepsy;
VA Form 21-0960C-7, Fibromyalgia Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of
fibromyalgia; VA Form 21-0960C-11, Seizure Disorders (Epilepsy)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any seizure disorder including epilepsy; VA
Form 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; VA Form 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 it excludes
diabetes; VA Form 21-0960E-3, Thyroid and Parathyroid Conditions
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any thyroid or parathyroid condition; VA
Form 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; VA Form 21-0960I-2, HIV-Related Illness Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any HIV-related illness; VA Form 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; VA Form
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;
VA Form 21-0960I-5, Nutritional Deficiencies Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of nutritional deficiencies; VA Form 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; VA Form 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; VA Form 21-
[[Page 19832]]
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; VA Form 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 or other diseases of the
nose, throat, larynx, or pharynx; VA Form 21-0960Q-1, Chronic Fatigue
Syndrome Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of chronic fatigue syndrome.
Affected Public: Individuals and households.
Estimated Annual Burden: 53,750 hours.
Estimated Average Burden per Respondent: 18.5 minutes per form (17
forms).
Frequency of Response: One-time.
Estimated Number of Respondents: 160,000.
By direction of the Secretary.
Danny S. Green,
VA Interim Clearance Officer, Office of Quality, Performance and Risk,
Department of Veterans Affairs.
[FR Doc. 2019-09203 Filed 5-3-19; 8:45 am]
BILLING CODE 8320-01-P
