2014-20472. Proposed Information Collection (Disability Benefits Questionnaires-Group 4) Activity: Comment Request

AGENCY:

Veterans Benefits Administration, Department of Veterans Affairs

ACTION:

Notice.

SUMMARY:

The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), 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 revision, and allow 60 days for public comment in response to the notice. This notice solicits comments for information needed to obtain medical evidence to adjudicate a claim for disability benefits.

DATES:

Written comments and recommendations on the proposed collection of information should be received on or before October 27, 2014.

ADDRESSES:

Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email to [e-mail]. Please refer to “OMB Control No. 2900-0781” in any correspondence. During the comment period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT:

Nancy J. Kessinger at [phone] or FAX [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, VBA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VBA's functions, including whether the information will have practical utility; (2) the accuracy of VBA'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.

Titles:

a. Cranial Nerve Conditions Disability Benefits Questionnaire, VA Form 21-0960-C-3.

b. Narcolepsy Disability Benefits Questionnaire, VA Form 21-0960-C-6.

c. Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire, VA Form 21-0960C-10.

d. Fibromyalgia Disability Benefits Questionnaire, VA Form 21-0960-C-7.

e. Seizure Disorders (Epilepsy) Disability Benefits Questionnaire, VA Form 21-0960-C-11.

f. Oral and Dental Conditions Including Mouth, Lips and Tongue (Other than Temporomandibular Joint Conditions) Disability Benefits Questionnaire, VA Form 21-0960-D-1.

g. Endocrine Diseases (other than Thyroid, Parathyroid or Diabetes Mellitus) Disability Benefits Questionnaire, VA Form 21-0960-E-2.

h. Thyroid & Parathyroid Conditions Disability Benefits Questionnaire, VA Form 21-0960-E-3.

l. Hernias (Including Abdominal, Inguinal, and Femoral Hernias) Disability Benefits Questionnaire, VA Form 21-0960-H-1.

m. HIV-Related Illnesses Disability Benefits Questionnaire, VA Form 21-0960-I-2.

n. Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue Syndrome, and Tuberculosis) Disability Benefits Questionnaire, VA Form 21-0960I-3.

o. Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases Disability Benefits Questionnaire, VA Form 21-0960-I-4.

p. Nutritional Deficiencies Disability Benefits Questionnaire, VA Form 21-0960-I-5.

q. Urinary Tract (including Bladder & Urethra) Conditions (excluding Male Reproductive System) Disability Benefits Questionnaire, VA Form 21-0960-J-4.

r. Respiratory Conditions (other than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire, VA Form 21-0960-L-1.

s. Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire, VA Form 21-0960-N-3.

t. Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx Disability Benefits Questionnaire, VA Form 21-0960-N-4.

u. Chronic Fatigue Syndrome Disability Benefits Questionnaire, VA Form 21-0960-Q-1.

OMB Control Number: 2900-0781.

Type of Review: Revised collection.

Abstract: Data collected on VA Form 21-0960 series will be used obtain information from claimants treating physician that is necessary to adjudicate a claim for disability benefits.

Affected Public: Individuals or households.

Estimated Annual Burden: 53,750 hours.

(a) VAF 21-0960-C-3—5,000

(b) VAF 21-0960-C-6—1,250

(c) VAF 21-0960-C-7—1,250

(d) VAF 21-0960-C-11—1,250

(e) VAF 21-0960-D-1—1,250

(f) VAF 21-0960-E-2—2,500

(g) VAF 21-0960-E-3—2,500

(h) VAF 21-0960-H-1—3,750

(i) VAF 21-0960-I-2—1,250

(j) VAF 21-0960-I-3—2,500

(k) VAF 21-0960-I-4—2,500

(l) VAF 21-0960-I-5—1,250

(m) VAF 21-0960-J-4—3,750

(n) VAF 21-0960-L-1—10,000

(o) VAF 21-0960-N-3—1,250

(p) VAF 21-0960-N-4—10,000

(q) VAF 21-0960-Q-1—2,500

Estimated Average Burden per Respondent:

(a) VAF 21-0960-C-3—30 minutes

(b) VAF 21-0960-C-6—15 minutes

(c) VAF 21-0960-C-7—15 minutes

(d) VAF 21-0960-C-11—15 minutes

(e) VAF 21-0960-D-1—15 minutes

(f) VAF 21-0960-E-2—15 minutes

(g) VAF 21-0960-E-3—15 minutes

(h) VAF 21-0960-H-1—15 minutes

(i) VAF 21-0960-I-2—15 minutes

(j) VAF 21-0960-I-3—15 minutes

(k) VAF 21-0960-I-4—30 minutes

(l) VAF 21-0960-I-5—15 minutes

(m) VAF 21-0960-J-4—15 minutes

(n) VAF 21-0960-L-1—30 minutes

(o) VAF 21-0960-N-3—15 minutes

(p) VAF 21-0960-N-4—30 minutes

(q) VAF 21-0960-Q-1—15 minutes

Frequency of Response: On occasion.

Estimated Number of Respondents: TOTAL: 160,000.

(a) VAF 21-0960-C-3—10,000

(b) VAF 21-0960-C-6—5,000

(c) VAF 21-0960-C-7—5,000

(d) VAF 21-0960-C-11—5,000

(e) VAF 21-0960-D-1—5,000

(f) VAF 21-0960-E-2—10,000

(g) VAF 21-0960-E-3—10,000

(h) VAF 21-0960-H-1—15,000

(i) VAF 21-0960-I-2—5,000

(j) VAF 21-0960-I-3—10,000

(k) VAF 21-0960-I-4—5,000

(l) VAF 21-0960-I-5—5,000

(m) VAF 21-0960-J-4—15,000

(n) VAF 21-0960-L-1—20,000

(o) VAF 21-0960-N-3—5,000

(p) VAF 21-0960-N-4—20,000

(q) VAF 21-0960-Q-1—10,000

Dated: August 25, 2014.

By direction of the Secretary.

Crystal Rennie,

VA Clearance Officer, Department of Veterans Affairs.