[Federal Register Volume 63, Number 9 (Wednesday, January 14, 1998)]
[Notices]
[Page 2302]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-827]
[[Page 2302]]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0080]
Proposed Information Collection Activity: Proposed Collection;
Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: The Veterans Health Administration (VHA) 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 reinstatement of a previously approved collection for
which approval has expired, and allow 60 days for public comment in
response to the notice. This notice solicits comments on information
needed to claim payment for reimbursement and to authorize and process
payment of medical and hospital services provided by a non-Federal
provider; and to authorize use of and process payment for ambulance and
other hired vehicle.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before March 16, 1998.
ADDRESSES: Submit written comments on the collection of information to
Ann Bickoff, Veterans Health Administration (161A1), Department of
Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420. Please
refer to ``OMB Control No. 2900-0080'' in any correspondence.
FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C., 3501-3520), 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, VHA
invites comments on: (1) Whether the proposed collection of information
is necessary for the proper performance of VHA's functions, including
whether the information will have practical utility; (2) the accuracy
of VHA'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) way 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.
Title: Claim for Payment of Cost of Unauthorized Medical Service,
Authority and Invoice for Travel by Ambulance or Other Hired Vehicle,
and Authorization and Invoice for Medical and Hospital Services.
Form Numbers:
a. VA Form 10-583, Claim for Payment of Cost of Unauthorized
Medical Service.
b. VA Form 10-2511, Authority and Invoice for Travel by Ambulance
or Other Hired Vehicle.
c. VA Form 10-7078, Authorization and Invoice for Medical and
Hospital Services.
OMB Control Number: 2900-0080.
Type of Review: Reinstatement, without change, of a previously
approved collection for which approval has expired.
Abstract:
a. VA Form 10-583 is used by administrative personnel in VA medical
facilities of fee jurisdiction to collect information for determining
legal and medical eligibility of applicants for payment or
reimbursement of the costs of unauthorized medical services obtained by
a veteran. The form is completed by the applicant as an official claim
for such benefits and by VA officials to certify the authorized payment
or reimbursement and to authorize such payment. If the collection of
information was not carried out, VA's ability to provide reimbursement
or payment for these costs would be negated.
b. Administrative personnel in VA medical facilities to authorize
expenditures from the beneficiary trust account use VA Form 10-2511. It
is also used to process payment for ambulance or other hired vehicular
forms of transportation to eligible veterans to and from VA health care
facilities for examination, treatment or care. If the collection of
information was not conducted, payment to vendors for services rendered
would not be possible.
c. VA Form 10-7078 is used by administrative personnel in VA
medical facilities to authorize expenditures from the medical care
account and process payment of medical and hospital services provided
by other than Federal health providers to VA beneficiaries. Without the
use of this form it would complicate management and record keeping of
expenditures for medical care provided at VA expense by the private
sector.
Affected Public: Business or other for-profit--Individuals or
households--Not-for-profit institutions--State, Local or Tribal
Government.
Estimated Total Annual Burden: 29,671 hours.
a. VA Form 10-583--17,188 hours.
b. VA Form 10-2511--4,083 hours.
c. VA Form 10-7078--8,400 hours.
Estimated Average Burden Per Respondent:
a. VA Form 10-583--15 minutes.
b. VA Form 10-2511--2 minutes.
c. VA Form 10-7078--2 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 443,250.
a. VA Form 10-2421--68,750.
b. VA Form 10-2520--122,500.
c. VA Form 10-2914--252,000.
Dated: December 10, 1997.
By direction of the Secretary
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 98-827 Filed 1-13-98; 8:45 am]
BILLING CODE 8320-01-P
