60-Day FRN (2900-0776)

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Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices
is to conduct a survey of Veterans to
capture novel predictors of hospital
admission and identify clusters of
complex patients based on survey- and
claims-based covariates. This study
provides the first empirical application
of the Cycle of Complexity conceptual
model that the study team developed
and recently published, which
postulates that patient complexity
represents more than having multiple
chronic conditions. It is critical to
evaluate whether complexity defined on
the basis of survey-based and claimsbased covariates is more predictive than
diagnosis of multiple chronic conditions
based on claims data alone.
The proposed patient survey is
designed to measure a broad range of
self-reported patient factors that
increase Veterans’ risk for being
admitted to hospital, including life
stressors, perceived locus of control,
grit, resilience, functional status, social
support and loneliness, sleep problems,
symptoms, food insecurity, and patient
activation. This survey will help us
understand, for the first time, the extent
to which self-reported factors can
markedly improve prediction of patient
risk for hospital admission, which may
help the PACT Demonstration Lab
Coordinating Center Intelligence
improve its risk prediction models. This
project may also identify patientreported outcomes (PROs) that can be
effectively integrated into routine VA
clinical practice, as the VA begins to
explore inclusion of PROs into the VA
electronic health record. We are
requesting approval to conduct this
survey to a nationally representative
sample of 10,000 patients who obtain
primary care in VA because there are no
extant VA surveys that capture the range
of patient factors that we propose to
collect, which are not available in VA
administrative databases. If we did not
capture these patient factors, our risk
prediction analysis might be incorrect or
biased.
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
Thursday, January 26, 2017, Volume 82,
No. 16, pages 8563–8564.
Affected Public: Individuals or
households.
Estimated Annual Burden: 2500.
Estimated Average Burden per
Respondent: 30 minutes.
Frequency of Response: Annually.
Estimated Annual Responses: 5,000.

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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. 2017–08442 Filed 4–25–17; 8:45 am]
BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0776]

Agency Information Collection
Activity: Artery and Vein Conditions
(Vascular Diseases Including Varicose
Veins) Disability Benefits
Questionnaire, Hypertension Disability
Benefits Questionnaire, Non-Ischemic
Heart Disease (Including Arrhythmias
and Surgery) Disability Benefits
Questionnaire, Diabetic Peripheral
Neuropathy (Diabetic Sensory-Motor
Peripheral Neuropathy) Disability
Benefits Questionnaire, Diabetes
Mellitus Disability Benefits
Questionnaire, Scars/Disfigurement
Disability Benefits Questionnaire, Skin
Diseases Disability Benefits
Questionnaire, Amputations Disability
Benefits Questionnaire, Muscles
Injuries Disability Benefits
Questionnaire, Temporomandibular
Joint (TMJ) Conditions Disability
Benefits Questionnaire, Eye
Conditions Disability Benefits
Questionnaire
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:

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 21–0960 series is used to
gather necessary information from a
claimant’s treating physician regarding
the results of medical 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

SUMMARY:

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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, Non-ischemic Heart Disease
(including Arrhythmias and Surgery)
Disability Benefits Questionnaire, will
gather information related to the
claimant’s diagnosis of any nonischemic 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.
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. 2900–0776’’ in any
correspondence. During the comment

ADDRESSES:

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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.

mstockstill on DSK30JT082PROD with NOTICES

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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