[Federal Register Volume 62, Number 101 (Tuesday, May 27, 1997)]
[Notices]
[Pages 28757-28758]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-13712]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0091]
Proposed Information Collection Activity: Proposed Collection;
Comment Request; Revision
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
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 revision of a currently approved collection, and allow 60
days for public comment in response to the notice. This notice solicits
comments on requirements relating to the collection of information from
veterans during the medical care application process and when making
funeral and burial arrangements.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before July 28, 1997.
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. 2900-0091'' 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 and Form Numbers: Application for Medical Benefits, VA Form
10-10; Insurance Information, VA Form 10-10I; Financial Worksheet, VA
Form 10-10F; and Funeral Arrangements, VA Form 10-2065.
OMB Control Number: 2900-0091.
Type of Review: Revision of a currently approved collection.
Abstract: The forms are used to collect information in connection
with providing medical care benefits, obtaining health insurance
information for third party billing purposes, obtaining income and
asset information, and for the purposes of making funeral and burial
arrangements for deceased veterans. The purpose of the collection of
information is outlined below:
a. VA Form 10-10 is used to establish a system of records on
veterans applying for medical benefits. The information is used to
identify the veterans applying for medical care, establish initial
eligibility for care, and to provide emergency contacts, employment
information, military service data, and income screening for pharmacy
co-payment.
b. VA Form 10-10F is used to collect financial information on
veterans whose eligibility for VA health care benefits is based on
income. Nonservice-connected veterans and noncompensable service-
connected veterans rated 0% seeking care for their nonservice-connected
conditions complete the form to establish their eligibility for cost-
free health care, mileage reimbursement and prescription co-payment
exemption benefits. Veterans with compensable service-connected
disabilities rated 0, 10 or 20% may provide their income information to
establish their eligibility for prescription co-payment exemption and
mileage reimbursement. Veterans with service-connected disabilities
rated 30 or 40% may provide their income information to determine their
eligibility for prescription co-payment exemption.
c. VA Form 10-10I is used to collect health insurance information
and to bill health insurance carries to recover the cost of medical
care furnished to veterans for treatment of nonservice-connected
conditions.
d. VA Form 10-2065 serves as an official record of the funeral
director to which the person making funeral arrangements wishes the
remains to be released. It is used as a control document when VA is
requested to arrange for the transportation of the deceased from the
place of death to the
[[Page 28758]]
place of burial, and/or when burial is requested in a National
Cemetery.
Affected Public: Individuals or households.
Estimated Annual Burden: 3,212,738 hours.
a. VA Form 10-10--2,175,000 hours.
b. VA Form 10-10F--454,667 hours.
c. VA Form 10-10I--580,000 hours.
d. VA Form 10-2065--3,071 hours.
Estimated Average Burden Per Respondent: 21 minutes.
a. VA Form 10-10--45 minutes.
b. VA Form 10-10F--20 minutes.
c. VA Form 10-10I--12 minutes.
d. VA Form 10-2064--5 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 7,198,850.
a. VA Form 10-10--2,900,000.
b. VA Form 10-10F--1,364,000.
c. VA Form 10-10I--2,900,000.
d. VA Form 10-2064--34,850.
Dated: May 15, 1997.
By direction of the Secretary.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 97-13712 Filed 5-23-97; 8:45 am]
BILLING CODE 8320-01-P
