Agency Information Collection Activity: Disability Benefits Questionnaire (Group 3), 66706-66707 [2019-26233]
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jbell on DSKJLSW7X2PROD with NOTICES
66706
Federal Register / Vol. 84, No. 234 / Thursday, December 5, 2019 / Notices
their tax obligations concerning
nonresident aliens to self-audit and
come into compliance with applicable
reporting and payment requirements.
Current Actions: There are no changes
being made to the revenue procedure at
this time.
Type of Review: Extension of a
currently approved collection.
Affected Public: Not-for-profit
institutions, and state, local or tribal
governments.
Estimated Number of Respondents:
495.
Estimated Time per Respondent: 700
hours.
Estimated Total Annual Burden
Hours: 346,500.
The following paragraph applies to all
of the collections of information covered
by this notice:
An agency may not conduct or
sponsor, and a person is not required to
respond to, a collection of information
unless the collection of information
displays a valid OMB control number.
Books or records relating to a collection
of information must be retained as long
as their contents may become material
in the administration of any internal
revenue law. Generally, tax returns and
tax return information are confidential,
as required by 26 U.S.C. 6103.
Request for Comments: Comments
submitted in response to this notice will
be summarized and/or included in the
request for OMB approval. All
comments will become a matter of
public record. Comments are invited on:
(a) Whether the collection of
information is necessary for the proper
performance of the functions of the
agency, including whether the
information shall have practical utility;
(b) the accuracy of the agency’s estimate
of the burden of the collection of
information; (c) ways to enhance the
quality, utility, and clarity of the
information to be collected; (d) ways to
minimize the burden of the collection of
information on respondents, including
through the use of automated collection
techniques or other forms of information
technology; and (e) estimates of capital
or start-up costs and costs of operation,
maintenance, and purchase of services
to provide information.
Approved: November 27, 2019.
Philippe Thomas,
IRS Supervisory Tax Analyst.
[FR Doc. 2019–26237 Filed 12–4–19; 8:45 am]
BILLING CODE 4830–01–P
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
Proposed Collection; Comment
Request for Regulation Project
Internal Revenue Service (IRS),
Treasury.
ACTION: Notice and request for
comments.
AGENCY:
The Internal Revenue Service,
as part of its continuing effort to reduce
paperwork and respondent burden,
invites the general public and other
Federal agencies to take this
opportunity to comment on information
collections, as required by the
Paperwork Reduction Act of 1995. The
IRS is soliciting comments concerning
Revenue Procedure 2004–12, Health
Insurance Costs of Eligible Individuals.
DATES: Written comments should be
received on or before February 3, 2020
to be assured of consideration.
ADDRESSES: Direct all written comments
to Dr. Philippe Thomas, Internal
Revenue Service, Room 6526, 1111
Constitution Avenue NW, Washington,
DC 20224.
FOR FURTHER INFORMATION CONTACT:
Requests for additional information or
copies of the information collection
should be directed to Sara Covington,
Internal Revenue Service, Room 6526,
1111 Constitution Avenue NW,
Washington, DC 20224, or at (202) 317–
6038, or through the internet at
Sara.L.Covington@irs.gov.
SUPPLEMENTARY INFORMATION:
Title: Health Insurance Costs of
Eligible Individuals.
OMB Number: 1545–1875.
Regulation Project Number: Rev. Proc.
2004–12.
Abstract: Revenue Procedure 2004–12
informs states how to elect a health
program to be qualified health insurance
for purposes of the health coverage tax
credit (HCTC) under section 35 of the
Internal Revenue Code. The collection
of information is voluntary. However, if
a state does not make an election,
eligible residents of the state may be
impeded in their efforts to claim the
HCTC.
Current Actions: There is no change
in the paperwork burden previously
approved by OMB.
Type of Review: Extension of a
currently approved collection.
Affected Public: States, Local or Tribal
Government.
Estimated Number of Respondents:
51.
Estimated Average Time per
Respondent: 30 minutes.
Estimate Total Annual Burden Hours:
26.
SUMMARY:
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The following paragraph applies to all
of the collections of information covered
by this notice:
An agency may not conduct or
sponsor, and a person is not required to
respond to, a collection of information
unless the collection of information
displays a valid OMB control number.
Books or records relating to a collection
of information must be retained as long
as their contents may become material
in the administration of any internal
revenue law. Generally, tax returns and
tax return information are confidential,
as required by 26 U.S.C. 6103.
Request for Comments: Comments
submitted in response to this notice will
be summarized and/or included in the
request for OMB approval. All
comments will become a matter of
public record. Comments are invited on:
(a) Whether the collection of
information is necessary for the proper
performance of the functions of the
agency, including whether the
information shall have practical utility;
(b) the accuracy of the agency’s estimate
of the burden of the collection of
information; (c) ways to enhance the
quality, utility, and clarity of the
information to be collected; (d) ways to
minimize the burden of the collection of
information on respondents, including
through the use of automated collection
techniques or other forms of information
technology; and (e) estimates of capital
or start-up costs and costs of operation,
maintenance, and purchase of services
to provide information.
Approved: November 27, 2019.
Philippe Thomas,
IRS Supervisory Tax Analyst.
[FR Doc. 2019–26236 Filed 12–4–19; 8:45 am]
BILLING CODE 4830–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0778]
Agency Information Collection
Activity: Disability Benefits
Questionnaire (Group 3)
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
SUMMARY:
E:\FR\FM\05DEN1.SGM
05DEN1
jbell on DSKJLSW7X2PROD with NOTICES
Federal Register / Vol. 84, No. 234 / Thursday, December 5, 2019 / Notices
concerning each proposed collection of
information, including each proposed
reinstatement 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 February 3, 2020.
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. 2900–0778’’ in any
correspondence. During the comment
period, comments may be viewed online
through FDMS.
FOR FURTHER INFORMATION CONTACT:
Danny 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
Questionnaires (Group 3).
OMB Control Number: 2900–0778.
Type of Review: Reinstatement of a
currently approved collection.
Abstract: VA Form 21–0960 series
called Disability Benefits Questionnaire
(Group 3) gathers 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 Questionnaires (Group 3) is
comprised of 17 forms. Each DBQ title
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includes the names of the specific
disability for which it gathers
information. VAF 21–0960C–5, Central
Nervous System and Neuromuscular
Diseases Disability Benefits
Questionnaire, gathers information
related to the claimant’s diagnosis of a
central nervous system disease; VAF
21–0960C–8, Headaches (Including
Migraine Headaches) Disability Benefits
Questionnaire, gathers information
related to the claimant’s diagnosis of
headaches; VAF 21–0960C–9, Multiple
Sclerosis (MS) Disability Benefits
Questionnaire, gathers 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, gathers information
related to the claimant’s diagnosis of
any esophageal disorders; VAF 21–
0960G–2, Gall Bladder and Pancreas
Conditions Disability Benefits
Questionnaire, gathers 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, gathers
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, gathers 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, gathers
information related to the claimant’s
diagnosis of any liver condition; VAF
21–0960G–6, Peritoneal Adhesions
Disability Benefits Questionnaire,
gathers 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, gathers 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,
gathers 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, gathers information
PO 00000
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Fmt 4703
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66707
related to the claimant’s diagnosis of
any rectum or anus condition, which
includes hemorrhoids; VAF 21–0960K–
1, Breast Conditions and Disorders
Disability Benefits Questionnaire,
gathers information related to the
claimant’s diagnosis of a breast
condition or disorder; VAF 21–0960K–
2, Gynecological Conditions Disability
Benefits Questionnaire, gathers
information related to the claimant’s
diagnosis of a gynecological condition;
VAF 21–0960L–2, Sleep Apnea
Disability Benefits Questionnaire,
gathers information related to the
claimant’s diagnosis of sleep apnea;
VAF 21–0960M–11, Osteomyelitis
Disability Benefits Questionnaire,
gathers information related to the
claimant’s diagnosis of osteomyelitis;
and VAF 21–0960N–1, Ear Conditions
(Including Vestibular and Infectious)
Disability Benefits Questionnaire,
gathers information related to the
claimant’s diagnosis of an ear disease.
Affected Public: Individuals and
households.
Estimated Annual Burden: 77,500
hours.
Estimated Average Burden per
Respondent: 19.4 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
250,000.
By direction of the Secretary.
Danny S. Green,
Department Clearance Officer, Office of
Quality, Privacy and Risk (OQPR),
Department of Veterans Affairs.
[FR Doc. 2019–26233 Filed 12–4–19; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0652]
Agency Information Collection
Activity: Request for Nursing Home
Information in Connection With Claim
for Aid and Attendance
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
SUMMARY:
E:\FR\FM\05DEN1.SGM
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]]>Agencies
[Federal Register Volume 84, Number 234 (Thursday, December 5, 2019)]
[Notices]
[Pages 66706-66707]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-26233]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0778]
Agency Information Collection Activity: Disability Benefits
Questionnaire (Group 3)
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
[[Page 66707]]
concerning each proposed collection of information, including each
proposed reinstatement 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 February 3, 2020.
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. 2900-0778'' in any correspondence. During the comment period,
comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Danny 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 Questionnaires (Group 3).
OMB Control Number: 2900-0778.
Type of Review: Reinstatement of a currently approved collection.
Abstract: VA Form 21-0960 series called Disability Benefits
Questionnaire (Group 3) gathers 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 Questionnaires (Group 3) is comprised of 17 forms.
Each DBQ title includes the names of the specific disability for which
it gathers information. VAF 21-0960C-5, Central Nervous System and
Neuromuscular Diseases Disability Benefits Questionnaire, gathers
information related to the claimant's diagnosis of a central nervous
system disease; VAF 21-0960C-8, Headaches (Including Migraine
Headaches) Disability Benefits Questionnaire, gathers information
related to the claimant's diagnosis of headaches; VAF 21-0960C-9,
Multiple Sclerosis (MS) Disability Benefits Questionnaire, gathers
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,
gathers information related to the claimant's diagnosis of any
esophageal disorders; VAF 21-0960G-2, Gall Bladder and Pancreas
Conditions Disability Benefits Questionnaire, gathers 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, gathers 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, gathers
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, gathers information
related to the claimant's diagnosis of any liver condition; VAF 21-
0960G-6, Peritoneal Adhesions Disability Benefits Questionnaire,
gathers 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, gathers 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, gathers 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,
gathers information related to the claimant's diagnosis of any rectum
or anus condition, which includes hemorrhoids; VAF 21-0960K-1, Breast
Conditions and Disorders Disability Benefits Questionnaire, gathers
information related to the claimant's diagnosis of a breast condition
or disorder; VAF 21-0960K-2, Gynecological Conditions Disability
Benefits Questionnaire, gathers information related to the claimant's
diagnosis of a gynecological condition; VAF 21-0960L-2, Sleep Apnea
Disability Benefits Questionnaire, gathers information related to the
claimant's diagnosis of sleep apnea; VAF 21-0960M-11, Osteomyelitis
Disability Benefits Questionnaire, gathers information related to the
claimant's diagnosis of osteomyelitis; and VAF 21-0960N-1, Ear
Conditions (Including Vestibular and Infectious) Disability Benefits
Questionnaire, gathers information related to the claimant's diagnosis
of an ear disease.
Affected Public: Individuals and households.
Estimated Annual Burden: 77,500 hours.
Estimated Average Burden per Respondent: 19.4 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 250,000.
By direction of the Secretary.
Danny S. Green,
Department Clearance Officer, Office of Quality, Privacy and Risk
(OQPR), Department of Veterans Affairs.
[FR Doc. 2019-26233 Filed 12-4-19; 8:45 am]
BILLING CODE 8320-01-P
