[Federal Register Volume 59, Number 249 (Thursday, December 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-32056]
[[Page Unknown]]
[Federal Register: December 29, 1994]
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DEPARTMENT OF VETERANS AFFAIRS
Information Collection Under OMB Review: Veterans, Patient,
Health Care Services, Advance Directive, Informed Consent
agency: Department of Veterans Affairs.
action: Notice.
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The Department of Veterans Affairs has submitted to OMB the
following proposal for the collection of information under the
provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). This
document lists the following information: (1) The title of the
information collection, and the Department form number(s), if
applicable; (2) a description of the need and its use; (3) who will be
required or asked to respond; (4) an estimate of the total annual
reporting hours, and recordkeeping burden, if applicable; (5) the
estimated average burden hours per respondent; (6) the frequency of
response; and (7) an estimated number of respondents.
addresses: Copies of the proposed information collection and supporting
documents may be obtained from Ann Bickoff, Veterans Health
Administration (161B4), Department of Veterans Affairs, 810 Vermont
Avenue, NW, Washington, DC 20420 (202) 535-7407.
Comments and questions about the items on the list should be
directed to VA's OMB Desk Officer, Joseph Lackey, NEOB, Room 10102,
Washington, DC 20503, (202) 395-7316. Do not send requests for benefits
to this address.
dates: Comments on the information collection should be directed to the
OMB Desk Officer on or before January 30, 1995.
Dated: December 21, 1994.
By direction of the Secretary:
Donald L. Neilson,
Director, Information Management Service.
Existing Collection in Use Without an OMB Control Number
1. Veterans, Patient, Health Care Services, Advance Directive,
Informed Consent
a. VA Living Will/VA Advance Directive, VA Form 10-0137A
b. VA DPAHC (Durable Power of Attorney for Health Care), VA Form
10-0137B
c. Treatment Preferences, VA Form 10-0137C
2. The forms are used to record a VA patient's specific
instructions about health care decision in the event the patient
becomes incompetent to make those choices. The information will be used
by VA health care professionals to make treatment decisions for
patients.
3. Individuals or households
4. Total Annual Hours requested--99,630
a. VA Form 10-0137A--25,410 hours
b. VA Form 10-0137B--35,310
c. VA Form 10-0137C--39,530
5. Estimated Average Burden Hours Per Respondent--25 minutes
a. VA Form 10-0137A--20 minutes
b. VA Form 10-0137B--20 minutes
c. VA Form 10-0137C--40 minutes
6. On occasion
7. Estimated Number of Respondents--243,000
a. VA Form 10-0137A--77,000 respondents
b. VA Form 10-0137B--107,000 respondents
c. VA Form 10-0137C--59,000 respondents.
[FR Doc. 94-32056 Filed 12-28-94; 8:45 am]
BILLING CODE 8320-01-M
