Agency Information Collection Activity: Request for Nursing Home Information in Connection With Claim for Aid and Attendance, 66707-66708 [2019-26240]

Download as PDF 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 VerDate Sep<11>2014 17:38 Dec 04, 2019 Jkt 250001 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 Frm 00059 Fmt 4703 Sfmt 4703 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 05DEN1 jbell on DSKJLSW7X2PROD with NOTICES 66708 Federal Register / Vol. 84, No. 234 / Thursday, December 5, 2019 / Notices 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 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. 2900–0652’’ 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: Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21– 0779). OMB Control Number: 2900–0652. Type of Review: Extension of a currently approved collection. Abstract: VA Form 21–0779 is used to gather the necessary information to determine eligibility for pension and aid and attendance benefits based on nursing home status. The form also requests information regarding Medicaid status and nursing home care charges, so VA can determine the proper rate of payment. Affected Public: Individuals and households. VerDate Sep<11>2014 17:38 Dec 04, 2019 Jkt 250001 Estimated Annual Burden: 10,188 hours. Estimated Average Burden per Respondent: 10 minutes. Frequency of Response: On occasion. Estimated Number of Respondents: 61,125. By direction of the Secretary: Danny S. Green, Department Clearance Officer, Office of Quality, Privacy and Risk (OQPR), Department of Veterans Affairs. [FR Doc. 2019–26240 Filed 12–4–19; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS Funding Availability Under Supportive Services for Veteran Families Program Department of Veterans Affairs. Notice of fund availability. AGENCY: ACTION: The Department of Veterans Affairs (VA) is announcing the availability of funds for supportive services grants under the Supportive Services for Veteran Families (SSVF) Program. This Notice of Fund Availability (NOFA) contains information concerning the SSVF Program, renewal of supportive services grant application processes, and the amount of funding available. Awards made for supportive services grants will fund operations beginning October 1, 2020. SUMMARY: Applications for supportive services grants under the SSVF Program must be received by the SSVF Program Office by 4:00 p.m. Eastern Time on January 31, 2020. In the interest of fairness to all competing applicants, this deadline is firm as to date and hour, and VA will treat as ineligible for consideration any application that is received after the deadline. Applicants should take this practice into account and make early submission of their materials to avoid any risk of loss of eligibility brought about by unanticipated delays, computer service outages, or other submission-related problems. DATES: For a Copy of the Application Package: Copies of the application can be downloaded from the SSVF website at www.va.gov/homeless/ ssvf. Questions should be referred to the SSVF Program Office by email at SSVF@ va.gov. For detailed SSVF Program information and requirements, see part 62 of Title 38, Code of Federal Regulations (CFR) (38 CFR part 62). Submission of Application Package: Applicants must submit applications ADDRESSES: PO 00000 Frm 00060 Fmt 4703 Sfmt 4703 electronically following instructions found at www.va.gov/homeless/ssvf. Applications may not be mailed or sent by facsimile (FAX). Applications must be received in the SSVF Program Office by 4:00 p.m. Eastern Time on the application deadline date. Applications must arrive as a complete package. Materials arriving separately will not be included in the application package for consideration and may result in the application being rejected. See Section II.C. of this NOFA for maximum allowable grant amounts. Technical Assistance: Information regarding how to obtain technical assistance with the preparation of a renewal supportive services grant application is available on the SSVF Program website at www.va.gov/ homeless/ssvf. FOR FURTHER INFORMATION CONTACT: Mr. John Kuhn, National Director, Supportive Services for Veteran Families, by email at SSVF@va.gov. SUPPLEMENTARY INFORMATION: Funding Opportunity Title: Supportive Services for Veteran Families Program. Announcement Type: Initial. Funding Opportunity Number: VA– SSVF–103119. Catalog of Federal Domestic Assistance Number: 64.033, VA Supportive Services for Veteran Families Program. I. Funding Opportunity Description A. Purpose: The SSVF Program’s purpose is to provide supportive services grants to private non-profit organizations and consumer cooperatives, who will coordinate or provide supportive services to very lowincome Veteran families who: (i) Are residing in permanent housing and at risk of becoming homeless; (ii) are homeless and scheduled to become residents of permanent housing within a specified time period; or (iii) after exiting permanent housing within a specified time period, are seeking other housing that is responsive to such very low-income Veteran family’s needs and preferences. SSVF prioritizes the delivery of rapid re-housing services to homeless Veteran households. Rapid re-housing is an intervention designed to help individuals and families quickly exit homelessness, return to housing in the community, and avoid homelessness again in the near term. The core components of a rapid re-housing program are housing identification, move-in and rent financial assistance, and rapid rehousing case management and services. These core components represent the E:\FR\FM\05DEN1.SGM 05DEN1

Agencies

[Federal Register Volume 84, Number 234 (Thursday, December 5, 2019)]
[Notices]
[Pages 66707-66708]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-26240]


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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

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

[[Page 66708]]

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 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. 2900-0652'' 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: Request for Nursing Home Information in Connection with 
Claim for Aid and Attendance (VA Form 21-0779).
    OMB Control Number: 2900-0652.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 21-0779 is used to gather the necessary 
information to determine eligibility for pension and aid and attendance 
benefits based on nursing home status. The form also requests 
information regarding Medicaid status and nursing home care charges, so 
VA can determine the proper rate of payment.
    Affected Public: Individuals and households.
    Estimated Annual Burden: 10,188 hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 61,125.

    By direction of the Secretary:
Danny S. Green,
Department Clearance Officer, Office of Quality, Privacy and Risk 
(OQPR), Department of Veterans Affairs.
[FR Doc. 2019-26240 Filed 12-4-19; 8:45 am]
 BILLING CODE 8320-01-P
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