60 Day FRN

DEPARTMENT OF VETERANS AFFAIRS Billing Code 8320-01

[OMB Control No. 2900-0188]

Proposed Information Collection (Claims, Authorization, and Invoice for Prosthetic items and Services) Activity: 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 information needed to identify areas for improvement in clinical training programs.

DATES: Written comments and recommendations on the proposed collection of information should be received on or before [Insert date 60 days after date of publication in the FEDERAL REGISTER].

ADDRESSES: Submit written comments on the collection of information through the Federal Docket Management System (FDMS) at www.Regulations.gov; or to Audrey Revere, Office of Regulatory and Administrative Affairs, Veterans Health Administration (10B4), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420 or e-mail: [email protected]. Please refer to "OMB Control No. 2900-0188” in any correspondence. During the comment period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Audrey Revere at (202) 461-5694.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Public Law 104-13; 44 U.S.C. 3501 - 3521), Federal agencies must obtain approval from 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.

Titles:

1. Veterans Application for Assistance in Acquiring Home Improvement and Structural Alterations, VA Form 10-0103.

2. Application for Adaptive Equipment for Motor Vehicle, VA Form 10-1394

3. Prosthetic Authorization for Items or Services, VA Form 10-2421

4. Request to Submit Quotation, VA Form Fl-10-90

5. Prescription Authorization for Glasses, VA Form 10-2914

6. Prosthetic Service Card Invoice, VA Form 10-2520

Type of Review: Renewal of a currently approved collection.

Abstracts:

1. VA Form 10-0103, Veterans Application for Assistance in Acquiring Home Improvement and Structural Alterations (HISA) grants, is used by the Prosthetic Service to determine eligibility/entitlement and reimbursement of individual claims for home improvement and structural alterations

2. VA Form 10-1394, Application for Adaptive Equipment Motor Vehicle.  This form is used by VHA Prosthetic Service, Fiscal Service and Veterans Benefits Administration to determine eligibility/entitlement and reimbursement of individual claims for automotive adaptive equipment. 

3. VA Form 10-2421, Prosthetic Authorization for Items or Services, is used for the direct procurement of new prosthetic appliances and/or services by PSAS (Prosthetic and Sensory Aids Service) under the COCP (Contracting Officers Certification Program). Warrants to PSAS personnel are authorized for open market and Federal Supply Schedule purchases, and decentralized and local beneficiary service contracts. 

4. VA Form 10-2520, Prosthetic Service Card Invoice, is used by the vendor as an invoice and billing document.

5. VA Form 10-2914, Prescription and Authorization for Fee Basis Eyeglasses, is used as a combination prescription, authorization and invoice. It purchases eyeglasses directly for veterans

6. Form Letter 10-90, Request to Submit Quotation, is used by the VAMC Prosthetics Service to request a quotation for items listed.

7. Affected Public: Individuals or households.

Estimated Annual Burden:

1. VA Form 10-0103– 583 hours.

2. VA Form 10-01394 – 1,000 hours

3. VA Form 10-2421 – 67 hours

4. VA Form 10-2520 – 47 hours

5. VA Form 10-2914 – 3,333 hours

6. VA Form Letter 10-90 – 708 hours.

Estimated Average Burden Per Respondent:

1. VA Form 10-0103 – 5 minutes

2. VA Form 10-1394 –15 minutes

3. VA Form 10-2421 – 4 minutes

4. VA Form 10-2520 – 4 minutes

5. VA Form 10-2914 – 4 minutes

6. VA Form Letter 10-90 – 5 minutes

Frequency of Response: Annually.

Estimated Annual Responses:

1. VA Form 10-0103 – 7,000

2. VA Form 10-1394 – 4,000

3. VA Form 10-2421 – 1,000

4. VA Form 10-2520 – 700

5. VA Form 10-2914 – 50,000

6. VA Form Letter 10-90 – 8,500

DATED:

By direction of the Secretary:

________________________________

Crystal Rennie

VA Clearance Officer

U.S. Department of Veterans Affairs.

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