60-day FRN Published on 04-26-17

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Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices

period, comments may be viewed online
through the FDMS.
FOR FURTHER INFORMATION CONTACT:
Nancy J. Kessinger at (202) 632–8924 or
FAX (202) 632–8925.
SUPPLEMENTARY INFORMATION: Under the
PRA of 1995, 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.

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Authority: Public Law 104–13; 44 U.S.C.
3501–21.

Title: (Artery and Vein Conditions
(Vascular Diseases Including Varicose
Veins) Disability Benefits Questionnaire
(VA Form 21–0960A–2), Hypertension
Disability Benefits Questionnaire (VA
Form 21–0960A–3), Non-Ischemic Heart
Disease (Including Arrhythmias and
Surgery) Disability Benefits
Questionnaire (VA Form 21–0960A–4),
Diabetic Peripheral Neuropathy
(Diabetic Sensory-Motor Peripheral
Neuropathy) Disability Benefits
Questionnaire (VA Form 21–0960C–4),
Diabetes Mellitus Disability Benefits
Questionnaire (VA Form 21–0960E–1),
Scars/Disfigurement Disability Benefits
Questionnaire (VA Form 21–0960F–1),
Skin Diseases Disability Benefits
Questionnaire (VA Form 21–0960F–2),
Amputations Disability Benefits
Questionnaire (VA Form 21–0960M–1),
Muscles Injuries Disability Benefits
Questionnaire (VA Form 21–0960M–
10), Temporomandibular Joint (TMJ)
Conditions Disability Benefits
Questionnaire (VA Form 21–0960M–
15), Eye Conditions Disability Benefits
Questionnaire (VA Form 21–0960N–2)).
OMB Control Number: 2900–0776.
Type of Review: Extension of an
approved collection.
Abstract: VA Form 21–0960 series is
used to gather necessary information
from a claimant’s treating physician
regarding the results of medical

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examinations. VA gathers medical
information related to the claimant that
is necessary to adjudicate the claim for
VA disability benefits. The Disability
Benefit Questionnaire title will include
the name of the specific disability for
which it will gather information. VAF
21–0960A–2, Artery and Vein
Conditions vascular diseases including
varicose veins) Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
arteries, veins, and/or peripheral
vascular disease; VAF 21–0960A–3,
Hypertension, Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
hypertension; VAF 21–0960A–4, Nonischemic Heart Disease (including
Arrhythmias and Surgery) Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any non-ischemic heart
disease; VAF 21–0960C–4, Diabetic
Peripheral Neuropathy (diabetic
sensory-motor peripheral neuropathy)
Disability Benefits Questionnaire will
gather information related to the
claimant’s diagnosis of a diabetic
sensory-motor peripheral neuropathy
condition; VAF 21–0960E–1, Diabetes
Mellitus Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
diabetes mellitus; VAF 21–0960F–1,
Scars/Disfigurement Disability Benefits
Questionnaire will gather information
related to the claimant’s diagnosis of
any scars or disfigurement; VAF 21–
0960F–2, Skin Diseases Disability
Benefits Questionnaire, will gather
information related to the claimant’s
diagnosis of any skin disease. VAF 21–
0960M–1 Amputations Disability
Benefits Questionnaire, will gather
information related to the claimant’s
amputations; VAF 21–0960M–10
Muscle Injuries Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of a
muscle injury disability. VAF 21–
0960M–15 Temporomandibular Joint
(TMJ) Conditions Disability Benefits
Questionnaire, will gather information
related to the claimant’s diagnosis of
temporomandibular joint dysfunction or
TMJ. VAF 21–0960N–2 Eye Conditions
Disability Benefits Questionnaire will
gather information related to the
claimant’s diagnosis of an eye
condition.
Affected Public: Individuals or
households.
Estimated Annual Burden: 162,500.
Estimated Average Burden per
Respondent: 25 minutes.
Frequency of Response: One time.
Estimated Number of Respondents:
400,000.

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By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[FR Doc. 2017–08440 Filed 4–25–17; 8:45 am]
BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0720]

Agency Information Collection
Activity: Operation Enduring Freedom/
Operation Iraqi Freedom Seriously
Injured/Ill Service Member Veteran
Worksheet
Veterans Benefits
Administration, Department of Veterans
Affairs.

AGENCY:

ACTION:

Notice.

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 proposed
revision of a currently approved
collection, and allow 60 days for public
comment in response to the notice. VA
Form 21–0773 is a checklist for Veterans
Service Representatives to verify they
have given information, applications,
and/or referral service to our Operation
Enduring Freedom or Operation Iraqi
Freedom service members who have at
least six months remaining on active
duty and who may have suffered a
serious injury or illness. This form will
be maintained in the veteran’s claims
folder.

SUMMARY:

Written comments and
recommendations on the proposed
collection of information should be
received on or before June 26, 2017.

DATES:

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
[email protected]. Please refer to
‘‘OMB Control No. 2900–0720 ’’ in any
correspondence. During the comment
period, comments may be viewed online
through the FDMS.

ADDRESSES:

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Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices

mstockstill on DSK30JT082PROD with NOTICES

FOR FURTHER INFORMATION CONTACT:

Nancy J. Kessinger at (202) 632–8924 or
FAX (202) 632–8925.
SUPPLEMENTARY INFORMATION: Under the
PRA of 1995, 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.
Authority: Public Law 104–13; 44
U.S.C. 3501–21.
Title: Operation Enduring Freedom/
Operation Iraqi Freedom Seriously
Injured/Ill Service Member Veteran
Worksheet (VA Form 21–0773).
OMB Control Number: 2900–0720.
Type of Review: Revision of an
approved collection.
Abstract: VA Form 21–0773 is a
checklist for Veterans Service
Representatives to verify they have
given information, applications, and/or
referral service to our Operation
Enduring Freedom or Operation Iraqi
Freedom service members who have at
least six months remaining on active
duty and who may have suffered a
serious injury or illness. This form will
be maintained in the veteran’s claims
folder.
Affected Public: Individuals or
households.
Estimated Annual Burden: 7,000
hours.
Estimated Average Burden per
Respondent: 30 minutes.
Frequency of Response: One time.
Estimated Number of Respondents:
14,000.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[FR Doc. 2017–08438 Filed 4–25–17; 8:45 am]
BILLING CODE 8320–01–P

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DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0091]

Agency Information Collection Activity
Under OMB Review: Application and
Renewal for Health Care Benefits
Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:

In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
Veterans Health Administration (VHA),
Department of Veterans Affairs, will
submit the collection of information
abstracted below to the Office of
Management and Budget (OMB) for
review and comment. The PRA
submission describes the nature of the
information collection and its expected
cost and burden; it includes the actual
data collection instrument.
DATES: Comments must be submitted on
or before May 26, 2017.
ADDRESSES: Submit written comments
on the collection of information through
www.Regulations.gov, or to Office of
Information and Regulatory Affairs,
Office of Management and Budget, Attn:
VA Desk Officer; 725 17th St. NW.,
Washington, DC 20503 or sent through
electronic mail to oira_submission@
omb.eop.gov. Please refer to ‘‘OMB
Control No. 2900–0091’’ in any
correspondence.
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor, Enterprise
Records Service (005R1B), Department
of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420,
(202) 461–5870 or email [email protected]. Please refer to ‘‘OMB
Control No. 2900–0091.’’
SUPPLEMENTARY INFORMATION:
SUMMARY:

Authority: 44 U.S.C. 3501–3521.

Titles:
1. Enrollment Application for VA
Health Care—VA Form 10–10EZ.
2. Application for Renewal of Health
Care Benefits—VA Form 10–10EZR.
3. Request for Hardship
Determination—VA Form 10–10HS.
OMB Control Number: 2900–0091.
Type of Review: Reinstatement.
Abstracts:
a. VA Form 10–10EZ collects
information only from new applicants
for VA medical care, nursing home,
domiciliary, dental benefits, and new
enrollees in the VA health care system.
b. VA Form 10–10EZR, Health
Benefits Renewal Form, is used to
collect data from those veterans who
wish to update their application data.

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19313

c. VA Form 10–10HS collects
information only from veterans who are
in a copay required status for hospital
care and medical services, but due to a
loss of income project their income for
the current year will be substantially
below the VA means test limits.
An agency may not conduct or
sponsor, and a person is not required to
respond to a collection of information
unless it displays a currently valid OMB
control number. The Federal Register
Notice with a 60-day comment period
soliciting comments on this collection
of information was published on
February 1, January 19, 2017, Volume
82, No. 20, page 8971.
Affected Public: Individuals or
households.
Estimated Annual Burden:
a. Enrollment Application for VA
Health Care—VA Form 10–10EZ—
270,000 hours.
b. Application for Renewal of Health
Care Benefits—VA Form 10–10EZR—
343,600 hours.
c. Request for Hardship
Determination—VA Form 10–10HS—
1,750 hours.
Estimated Average Burden per
Respondent:
a. Enrollment Application for VA
Health Care—VA Form 10–10EZ—30
minutes.
b. Application for Renewal of Health
Care Benefits—VA Form 10–10EZR—24
minutes.
c. Request for Hardship
Determination—VA Form 10–10HS—15
minutes.
Frequency of Response: Annually.
Estimated Annual Responses:
a. Enrollment Application for VA
Health Care—VA Form 10–10EZ—
540,000.
b. Application for Renewal of Health
Care Benefits—VA Form 10–10EZR—
859,000.
c. Request for Hardship
Determination—VA Form 10–10HS—
7,000.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise
Records Service, Office of Quality and
Compliance, Department of Veterans Affairs.
[FR Doc. 2017–08441 Filed 4–25–17; 8:45 am]
BILLING CODE 8320–01–P

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