[Federal Register Volume 59, Number 137 (Tuesday, July 19, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-17423]
[[Page Unknown]]
[Federal Register: July 19, 1994]
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DEPARTMENT OF VETERANS AFFAIRS
Information Collection Under OMB Review: Funeral Arrangements, VA
Form 10-2065; Application for Medical Benefits, VA Form 10-10;
Financial Worksheet, VA Form 10-10F; Insurance Information, VA Form 10-
101; and Spouse's Verification of Income, Form Letter 10-490
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 3002,
Washington, DC 20503, (202) 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 August 18, 1994.
Dated: June 29, 1994.
By direction of the Secretary.
Donald L. Neilson,
Director, Records Management Service.
Revision
1. The Title and Form Number.
a. Funeral Arrangements, VA Form 10-2065.
b. Application for Medical Benefits, VA Form 10-10.
c. Financial Worksheet, VA Form 10-10F.
d. Insurance Information, VA Form 10-10I.
e. Spouse's Verification of Income, Form Letter 10-490.
2. Description of the Need and Use.
a. VA Form 10-2065 is used primarily in VA medical facilities and
serves as an official records of the funeral director to which the
person making funeral arrangements wishes the remains to be released.
b. VA Form 10-10 is used primarily in VA medical facilities to
collect information to determine eligibility of applicants for VA
medical benefits.
c. VA Form 10-10F is used by VA personnel to determine the
eligibility for VA medical care of those veterans who must certify
their inability to defray the cost of needed medical care through
resources other than VA.
d. VA Form 10-10I is used by VA personnel to complete claims to
health insurance carriers which will allow VA to recover the cost of
medical care furnished to veterans for treatment of nonservice-
connected conditions.
e. Form Letter 10-490 is used by VA personnel for spouses of
veterans whose eligibility for VA medical care is based on income.
3. Individuals or households.
4. Estimated Total Annual Reporting Hours--3,210,303.
a. VA Form 10-2065--3,071 hours.
b. VA Form 10-10--2,175,000 hours.
c. VA Form 10-10F--454,667 hours.
d. VA Form 10-10I--580,000 hours.
e. Form Letter 10-490--
5. Estimated Average Burden Hours Per Respondent.
a. VA Form 10-2064--5 minutes.
b. VA Form 10-10--45 minutes.
c. VA Form 10-10F--20 minutes.
d. VA Form 10-10I--12 minutes.
e. Form Letter 10-490--None, for verification only.
6. On occasion.
7. Estimated Number of Respondents--9,000,850.
a. VA Form 10-2064--34,850.
b. VA Form 10-10--2,900,000.
c. VA Form 10-10F--1,364,000.
d. VA Form 10-10I--2,900,000.
e. Form Letter 10-490--1,800,000.
[FR Doc. 94-17423 Filed 7-18-94; 8:45 am]
BILLING CODE 8320-01-M
