30-day FRN - Expanded Access to Non-VA Care - Veterans Community Care Program (VCCP)

Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices
information collection request at
www.reginfo.gov.

DEPARTMENT OF VETERANS
AFFAIRS

SUPPLEMENTARY INFORMATION:

[OMB Control No. 2900–0823]

Title: Request for Transfer of Property
Seized/Forfeited by a Treasury
Forfeiture Fund Participating Agency.
OMB Control Number: 1505–0152.
Type of Review: Revision of a
currently approved request.
Description: This form is an
application from local law enforcement
entities to the Treasury Department to
request a percentage of proceeds or
tangible property that has been seized/
forfeited by the federal government.
Form: TD F 92–22.46.
Affected Public: Federal, state and
local law enforcement agencies
participating in the Department of the
Treasury Asset Sharing Program.
Estimated Number of Respondents:
7,000.
Frequency of Response: On Occasion.
Estimated Total Number of Annual
Responses: 7,000.
Estimated Time per Response: 30
Minutes.
Estimated Total Annual Burden
Hours: 3,500.
Request for Comments: Comments
submitted in response to this notice will
be summarized and included in the
request for Office of Management and
Budget approval. All comments will
become a matter of public record.
Comments are invited on: (a) Whether
the collection of information is
necessary for the proper performance of
the functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
collection of information; (c) ways to
enhance the quality, utility, and clarity
of the information to be collected; (d)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of technology; and (e) estimates of
capital or start-up costs and costs of
operation, maintenance, and purchase
of services required to provide
information.

Agency Information Collection Activity
Under OMB Review: Expanded Access
to Non-VA Care Through the MISSION
Act: Veterans Community Care
Program

Authority: 44 U.S.C. 3501 et seq.
Dated: November 27, 2020.
Spencer W. Clark,
Treasury PRA Clearance Officer.
[FR Doc. 2020–26583 Filed 12–1–20; 8:45 am]
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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,
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, and it includes the
actual data collection instrument.
DATES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function. Refer to ‘‘OMB Control
No. 2900–0823.’’
FOR FURTHER INFORMATION CONTACT:
Danny S. Green, Office of Quality,
Performance and Risk (OQPR),
Department of Veterans Affairs, 810
Vermont Avenue NW, Washington, DC
20420, (202) 421–1354 or email
[email protected] Please refer to
‘‘OMB Control No. 2900–0823’’ in any
correspondence.
SUMMARY:

SUPPLEMENTARY INFORMATION:

Authority: 44 U.S.C. 3501–21.
Title: Expanded Access to Non-VA
Care through the MISSION Act:
Veterans Community Care Program (VA
Forms 10–10143, 10–10143a, 10–
10143b, 10–10143c, 10–10143e, 10–
10143f and 10–10143g).
OMB Control Number: 2900–0823.
Type of Review: Revision and
extension of a currently approved
collection.
Abstract: Section 101 of the VA
Maintaining Internal Systems and
Strengthening Integrated Outside
Networks (MISSION) Act of 2018
requires VA to implement the Veterans
Community Care Program to furnish
care in the community to covered
Veterans through eligible entities and

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providers, under circumstances as
further prescribed in the MISSION Act.
VA currently collects information that
will be required to implement the
Veterans Community Care Program
(VCCP) under the Veterans Choice
Program, through an OMB approved
collection 2900–0823.
OMB Collection 2900–0823 now
includes VA Form 10–10143, Election to
Receive Authorized Non-VA Care and
Selection of Provider for the Veterans
Community Care Program; VA Form 10–
10143a, Veterans Community Care
Health Insurance Certification; VA Form
10–10143b, Submission of Medical
Record Information under the Veterans
Community Care Program; VA Form 10–
10143c, Submission of Information on
Credentials and Licenses by Eligible
Entities and Providers; and VA Form
10–10143e, Secondary Authorization
Request for VA Community Care. In
addition, two new forms that received
emergency PRA clearances from OMB in
2020 are included in 2900–0823: VA
Form 10–10143f, Community Care
Document Cover Sheet; and VA Form
10–10143g, Non-VA Hospital
Emergency Notification.
VA seeks to update OMB collection
2900–0823 to implement the Veterans
Community Care Program by updating
the title of VA forms and any associated
statutory citations to be consistent with
the new program and the MISSION Act,
by adding a new cover sheet to use
when submitting documentation from
providers of non-VA emergent care, by
adding a new 72-hour notification form
to be used when a Veteran receives
emergent care from a non-VA provider,
and by updating burden hours to
account for estimated increased use of
community care under the new
program.
This collection of information is
required to properly adjudicate and
implement the requirements of the
MISSION Act.
a. VA Form 10–10143 will collect
Veteran information on whether covered
Veterans would elect to receive
authorized care under the Veterans
Community Care Program (VCCP) if
certain conditions are met, as required
by 38 U.S.C. 1703(d)(3). This form also
will allow a covered Veteran to specify
a particular non-VA entity or provider.
b. VA Form 10–10143a will collect
other health insurance information from
covered Veterans who elect to
participate in the VCCP, as required by
38 U.S.C. 1705A. This information also
is required by 38 U.S.C. 1703(j), which
requires VA to recover or collect
reasonable charges for community care
that is furnished from a health care plan
contract described in 38 U.S.C. 1729.

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Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices

c. VA Form 10–10143b will collect
health records of covered Veterans from
non-VA health care entities and
providers for care authorized under the
VCCP, as required by 38 U.S.C.
1703(a)(2)(A), which requires VA to
establish a mechanism to receive
medical records from non-VA providers.
A copy of all medical and dental records
(including but not limited to images,
test results, and notes or other records
of what care was provided and why)
related to a Veteran’s care provided
under the VCCP must be submitted to
VA, including any claims for payment
for the furnishing of such care.
d. VA Form 10–10143c will collect
information from non-VA entities and
providers concerning relevant
credentials and licenses as required for
such entities or providers to furnish care
and services generally. This information
is authorized by section 133 of the
MISSION Act, which requires VA to
establish competency standards for nonVA providers, as well as 38 U.S.C.
1703C(a)(1), which requires VA to
establish certain standards of quality for
furnishing care and services (including
through non-VA providers).
e. VA Form 10–10143e will collect
secondary authorization requests from
non-VA entities and providers to
furnish care and services in addition to
or supporting the original authorization
for care. This information is required by
38 U.S.C. 1703(a)(3), which establishes
that a covered Veteran may only receive
care or services under the VCCP upon
VA’s authorization of such care or
services.
f. VA Form 10–10143f will allow for
the submission of paper documents in
support of a non-VA provider claim for
emergency care rendered in the
community when not accompanied by a
paper Health Care Claim form. This
Community Care Document Cover Sheet
will be used exclusively for the
submission of medical documentation
for unauthorized emergent services for
patients otherwise covered by VA.
g. VA Form 10–10143g will be used
to provide 72-hour notification to VA
when a Veteran receives emergent care
from a non-VA provider. This form
should be completed by the non-VA
provider within 72 hours of the
beginning of treatment.
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 at 85 FR
158 on August 14, 2020, pages 49720
and 49721.

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VA Form 10–10143
Affected Public: Individuals or
households.
Estimated Annual Burden: 610,833
hours.
Estimated Average Burden per
Respondent: 10 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
3,665,000.
VA Form 10–10143a
Affected Public: Individuals or
households.
Estimated Annual Burden: 610,833
hours.
Estimated Average Burden per
Respondent: 10 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
3,665,000.
VA Form 10–10143b
Affected Public: Private Sector.
Estimated Annual Burden: 1,039,332
hours.
Estimated Average Burden per
Respondent: 5 minutes.
Frequency of Response: Average of 34
times annually.
Estimated Number of Respondents:
366,823.
VA Form 10–10143c
Affected Public: Private Sector.
Estimated Annual Burden: 10,190
hours.
Estimated Average Burden per
Respondent: 5 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
122,274.
VA Form 10–10143e
Affected Public: Private Sector.
Estimated Annual Burden: 611,372
hours.
Estimated Average Burden per
Respondent: 20 minutes.
Frequency of Response: Average of 5
times annually.
Estimated Number of Respondents:
366,823.
VA Form 10–10143f
Affected Public: Private Sector.
Estimated Annual Burden: 41,667
hours.
Estimated Average Burden per
Respondent: 5 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
500,000.
VA Form 10–10143g
Affected Public: Private Sector.

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Estimated Annual Burden: 83,333
hours.
Estimated Average Burden per
Respondent: 10 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
500,000.
By direction of the Secretary.
Danny S. Green,
Interim VA Clearance Officer, Office of
Quality, Performance and Risk (OQPR),
Department of Veterans Affairs.
[FR Doc. 2020–26575 Filed 12–1–20; 8:45 am]
BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0882]

Agency Information Collection Activity
Under OMB Review: Chapter 31
Request for Assistance
Veterans Benefits
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:

In compliance with the
Paperwork Reduction Act (PRA) of
1995, this notice announces that the
Veterans Benefits Administration,
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 and it includes the
actual data collection instrument.
DATES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function. Refer to ‘‘OMB Control
No. 2900–0882.
FOR FURTHER INFORMATION CONTACT:
Danny S. Green, Enterprise Records
Service (005R1B), Department of
Veterans Affairs, 811 Vermont Avenue
NW, Washington, DC 20420, (202) 421–
1354 or email [email protected].
Please refer to ‘‘OMB Control No. 2900–
0882’’ in any correspondence.
SUPPLEMENTARY INFORMATION:
Authority: 38 U.S.C. 3100, 38 U.S.C.
501.
Title: Chapter 31 Request for
Assistance (VA Form 28–10212).
OMB Control Number: 2900–0882.
SUMMARY:

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