04-12949. Proposed Information Collection Activity: Proposed Collection; Comment Request

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 extension of a currently approved collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on the need to obtain written consent from a patient to disclose his or her medical record to private insurance companies, physicians and other third party.

DATES:

Written comments and recommendations on the proposed collection of information should be received on or before August 9, 2004.

ADDRESSES:

Submit written comments on the collection of information to Ann Bickoff, Veterans Health Administration (19E1), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-mail [e-mail]. Please refer to “OMB Control No. 2900-0260” in any correspondence.

FOR FURTHER INFORMATION CONTACT:

Ann Bickoff at [phone].

SUPPLEMENTARY INFORMATION:

Under the PRA of 1995 (Pub. L. 104-13; 44 U.S.C., 3501-3521), 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) 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.

Title: Request for and Consent to Release of Medical Records Protected by 38 U.S.C. 7332, VA Form 10-5345.

OMB Control Number: 2900-0260.

Type of Review: Extension of a currently approved collection.

Abstract: VA Form 10-5345 is used to obtain prior written consent from a patient before information concerning treatment for alcoholism or alcohol abuse, drug abuse, sickle cell anemia, or infection with the human immunodeficiency virus (HIV) can be disclosed from his or her medical record. This special consent must indicate the name of the facility permitted to make the disclosure, name of the individual or organization to whom the information is being released, specify the particular records or information to be released, and be under the signature of the veteran and dated. It must reflect the purpose the information is to be used, and include a statement that the consent is subject to revocation and the date, event or condition upon which the consent will expire if not revoked before.

VA personnel complete 50 percent of the form and the patient completes the remaining 50 percent. If VA did not collect this information, the information could not be released from the patient's records. This would have a negative impact on patients who need and want information released to private insurance companies, physicians and other third parties.

Affected Public: Business or other for profit and Individuals or households.

Estimated Total Annual Burden: 16,667 hours.

Estimated Average Burden Per Respondent: 2 minutes.

Frequency of Response: One-time.

Estimated Number of Respondents: 500,000.

Dated: May 28, 2004.

By direction of the Secretary:

Loise Russell,

Director, Records Management Service.