Agency Information Collection Activity Under OMB Review: Chapter 31 Request for Assistance, 77488-77489 [2020-26566]

Download as PDF 77488 Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices c. VA Form 10–10143b will collect health records of covered Veterans from non-VA health care entities and providers for care authorized under the VCCP, as required by 38 U.S.C. 1703(a)(2)(A), which requires VA to establish a mechanism to receive medical records from non-VA providers. A copy of all medical and dental records (including but not limited to images, test results, and notes or other records of what care was provided and why) related to a Veteran’s care provided under the VCCP must be submitted to VA, including any claims for payment for the furnishing of such care. d. VA Form 10–10143c will collect information from non-VA entities and providers concerning relevant credentials and licenses as required for such entities or providers to furnish care and services generally. This information is authorized by section 133 of the MISSION Act, which requires VA to establish competency standards for nonVA providers, as well as 38 U.S.C. 1703C(a)(1), which requires VA to establish certain standards of quality for furnishing care and services (including through non-VA providers). e. VA Form 10–10143e will collect secondary authorization requests from non-VA entities and providers to furnish care and services in addition to or supporting the original authorization for care. This information is required by 38 U.S.C. 1703(a)(3), which establishes that a covered Veteran may only receive care or services under the VCCP upon VA’s authorization of such care or services. f. VA Form 10–10143f will allow for the submission of paper documents in support of a non-VA provider claim for emergency care rendered in the community when not accompanied by a paper Health Care Claim form. This Community Care Document Cover Sheet will be used exclusively for the submission of medical documentation for unauthorized emergent services for patients otherwise covered by VA. g. VA Form 10–10143g will be used to provide 72-hour notification to VA when a Veteran receives emergent care from a non-VA provider. This form should be completed by the non-VA provider within 72 hours of the beginning of treatment. 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 at 85 FR 158 on August 14, 2020, pages 49720 and 49721. VerDate Sep<11>2014 17:39 Dec 01, 2020 Jkt 253001 VA Form 10–10143 Affected Public: Individuals or households. Estimated Annual Burden: 610,833 hours. Estimated Average Burden per Respondent: 10 minutes. Frequency of Response: Once annually. Estimated Number of Respondents: 3,665,000. VA Form 10–10143a Affected Public: Individuals or households. Estimated Annual Burden: 610,833 hours. Estimated Average Burden per Respondent: 10 minutes. Frequency of Response: Once annually. Estimated Number of Respondents: 3,665,000. VA Form 10–10143b Affected Public: Private Sector. Estimated Annual Burden: 1,039,332 hours. Estimated Average Burden per Respondent: 5 minutes. Frequency of Response: Average of 34 times annually. Estimated Number of Respondents: 366,823. VA Form 10–10143c Affected Public: Private Sector. Estimated Annual Burden: 10,190 hours. Estimated Average Burden per Respondent: 5 minutes. Frequency of Response: Once annually. Estimated Number of Respondents: 122,274. VA Form 10–10143e Affected Public: Private Sector. Estimated Annual Burden: 611,372 hours. Estimated Average Burden per Respondent: 20 minutes. Frequency of Response: Average of 5 times annually. Estimated Number of Respondents: 366,823. VA Form 10–10143f Affected Public: Private Sector. Estimated Annual Burden: 41,667 hours. Estimated Average Burden per Respondent: 5 minutes. Frequency of Response: Once annually. Estimated Number of Respondents: 500,000. VA Form 10–10143g Affected Public: Private Sector. PO 00000 Frm 00064 Fmt 4703 Sfmt 4703 Estimated Annual Burden: 83,333 hours. Estimated Average Burden per Respondent: 10 minutes. Frequency of Response: Once annually. Estimated Number of Respondents: 500,000. 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. 2020–26575 Filed 12–1–20; 8:45 am] BILLING CODE 8320–01–P DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900–0882] Agency Information Collection Activity Under OMB Review: Chapter 31 Request for Assistance Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. AGENCY: In compliance with the Paperwork Reduction Act (PRA) of 1995, this notice announces that the Veterans Benefits Administration, 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 and it includes the actual data collection instrument. DATES: Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/public/do/ PRAMain. Find this particular information collection by selecting ‘‘Currently under 30-day Review—Open for Public Comments’’ or by using the search function. Refer to ‘‘OMB Control No. 2900–0882. FOR FURTHER INFORMATION CONTACT: Danny S. Green, Enterprise Records Service (005R1B), Department of Veterans Affairs, 811 Vermont Avenue NW, Washington, DC 20420, (202) 421– 1354 or email danny.green2@va.gov. Please refer to ‘‘OMB Control No. 2900– 0882’’ in any correspondence. SUPPLEMENTARY INFORMATION: Authority: 38 U.S.C. 3100, 38 U.S.C. 501. Title: Chapter 31 Request for Assistance (VA Form 28–10212). OMB Control Number: 2900–0882. SUMMARY: E:\FR\FM\02DEN1.SGM 02DEN1 Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices Type of Review: Extension of a currently approved collection. Abstract: VA Form 28–10212 is used to gather specific information regarding a claimant’s request for services, supplies, or equipment that are necessary to participate in the Chapter 31 program. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information VerDate Sep<11>2014 17:39 Dec 01, 2020 Jkt 253001 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 at insert citation date, 85 FR 182 on September, 18, 2020, pages 58428 and 58429. Affected Public: Individuals. Estimated Annual Burden: 83. Estimated Average Burden per Respondent: 10 minutes. PO 00000 Frm 00065 Fmt 4703 Sfmt 9990 77489 Frequency of Response: One time. Estimated Number of Respondents: 500. By direction of the Secretary. Danny S. Green, VA PRA Clearance Officer, Office of Quality, Performance and Risk, Department of Veterans Affairs. [FR Doc. 2020–26566 Filed 12–1–20; 8:45 am] BILLING CODE 8320–01–P E:\FR\FM\02DEN1.SGM 02DEN1

Agencies

[Federal Register Volume 85, Number 232 (Wednesday, December 2, 2020)]
[Notices]
[Pages 77488-77489]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-26566]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0882]


Agency Information Collection Activity Under OMB Review: Chapter 
31 Request for Assistance

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
this notice announces that the Veterans Benefits Administration, 
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 and it 
includes the actual data collection instrument.

DATES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function. Refer to 
``OMB Control No. 2900-0882.

FOR FURTHER INFORMATION CONTACT: Danny S. Green, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 811 Vermont Avenue 
NW, Washington, DC 20420, (202) 421-1354 or email [email protected]. 
Please refer to ``OMB Control No. 2900-0882'' in any correspondence.

SUPPLEMENTARY INFORMATION: 
    Authority: 38 U.S.C. 3100, 38 U.S.C. 501.
    Title: Chapter 31 Request for Assistance (VA Form 28-10212).
    OMB Control Number: 2900-0882.

[[Page 77489]]

    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 28-10212 is used to gather specific information 
regarding a claimant's request for services, supplies, or equipment 
that are necessary to participate in the Chapter 31 program.
    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 at insert citation date, 85 FR 182 on 
September, 18, 2020, pages 58428 and 58429.
    Affected Public: Individuals.
    Estimated Annual Burden: 83.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 500.

    By direction of the Secretary.
Danny S. Green,
VA PRA Clearance Officer, Office of Quality, Performance and Risk, 
Department of Veterans Affairs.
[FR Doc. 2020-26566 Filed 12-1-20; 8:45 am]
BILLING CODE 8320-01-P
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