30-day FRN - 2900-0219 - CHAMPVA Benefits Forms - published 10302024

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Federal Register / Vol. 89, No. 210 / Wednesday, October 30, 2024 / Notices

5. Title: Records to be made and
retained by financial institutions (31
CFR 1010.410 and 31 CFR 1022.420).
OMB Control Number: 1506–0058.
Type of Review: Extension without
change of a currently approved
collection.
Description: Each financial institution
must retain an original or copy of
records related to extensions of credit in
excess of $10,000 (other than those
secured by real property), and records
related to transfers of funds, currency,
other monetary instruments, checks,
investment securities, or credit of more
than $10,000 to or from the United
States (31 CFR 1010.410(a) through (d)).
Banks and non-bank financial
institutions must also maintain records
related to, and include certain
information as part of, funds transfers or
transmittals of funds involving more
than $3,000 (31 CFR 1010.410(e) and
(f)).
In addition, under 31 CFR 1022.420,
each provider or seller of prepaid access
is required to maintain access to
transactional records generated in the
ordinary course of business that would
be needed to reconstruct prepaid access
activation, loads, reloads, purchases,
withdrawals, transfers, or other prepaidrelated transactions.
Form: None.
Affected Public: Financial
Institutions.
Estimated Number of Respondents:
273,832.
Frequency of Response: On occasion.
Estimated Total Number of Annual
Responses: 320,352.
Estimated Time per Response: Varies
from 5 to 50 hours depending on
requirement and type of institution.
Estimated Total Annual Burden
Hours: 4,015,839.
6. Title: Additional Records to be
Made and Retained by Banks (31 CFR
1020.410).
OMB Control Number: 1506–0059.
Type of Review: Extension without
change of a currently approved
collection.
Description: A bank must retain an
original or copy of certain records, as
specified in section 31 CFR 1020.410.
Form: None.
Affected Public: Banks.
Estimated Number of Respondents:
10,062.
Frequency of Response: On occasion.
Estimated Total Number of Annual
Responses: 10,062.
Estimated Time per Response: 100
hours.
Estimated Total Annual Burden
Hours: 1,006,200.

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(Authority: 44 U.S.C. 3501 et seq.)
Spencer W. Clark,
Treasury PRA Clearance Officer.
[FR Doc. 2024–25231 Filed 10–29–24; 8:45 am]
BILLING CODE 4810–02–P

DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900–0219]

Agency Information Collection Activity
Under OMB Review: CHAMPVA
Benefits—Application, Claim, Other
Health Insurance, Potential Liability &
Miscellaneous Expenses
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 (VA),
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.

SUMMARY:

Comments and
recommendations for the proposed
information collection should be sent by
November 29, 2024.
ADDRESSES: To submit comments and
recommendations for the proposed
information collection, please type the
following link into your browser:
www.reginfo.gov/public/do/PRAMain,
select ‘‘Currently under Review—Open
for Public Comments,’’ then search the
list for the information collection by
Title or ‘‘OMB Control No. 2900–0219.’’
FOR FURTHER INFORMATION CONTACT: VA
PRA information: Maribel Aponte, 202–
461–8900, vacopaperworkreduact@
va.gov.
DATES:

SUPPLEMENTARY INFORMATION:

Title: CHAMPVA Benefits—
Application, Claim, Other Health
Insurance, Potential Liability &
Miscellaneous Expenses.
OMB Control Number: 2900–0219.
https://www.reginfo.gov/public/do/
PRASearch.
Type of Review: Revision of a
currently approved collection.
Abstract: The information collection
includes several forms, as well as a
review and appeal process, which are
used to administer the Civilian Health

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And Medical Program of the Department
of Veterans Affairs (CHAMPVA). The
collection is revised to include an
increase in burden hours based on
program data that reflects an increase in
claim submissions, OHI forms, appeals
and clinical reviews due to increased
enrollment. The collection also includes
a portal for submission of the
information in the 10–10d program
application form, which is expected to
be completed by the end of calendar
year 2024. This portal will allow
applicants to complete and submit VA
Form 10–10d electronically rather than
by submission of a hard copy form,
which has been the standard application
process prior to technological
advancement allowing electronic
submission and processing. This portal
represents a separate avenue for
applicants to submit VA Form 10–10d;
however, it does not affect the burden
of collection for applicants or VA.
VA Form 10–10d: Application for
CHAMPVA Benefits
VA Form 10–7959a: CHAMPVA Claim
Form
VA Form 10–7959c: CHAMPVA Other
Health Insurance (OHI) Certification
VA Form 10–7959d: CHAMPVA
Potential Liability Claim
VA Form 10–7959e: VA Claim for
Miscellaneous Expenses
Review and Appeal Process
Clinical Review
a. VA Form 10–10d, Application for
CHAMPVA Benefits, is used to
determine eligibility of persons
applying for healthcare benefits under
the CHAMPVA program in accordance
with 38 U.S.C. 501 and 1781.
b. VA Form 10–7959a, CHAMPVA
Claim Form, is used to adjudicate
claims for CHAMPVA benefits in
accordance with 38 U.S.C. 501 and
1781, and 10 U.S.C. 1079 and 1086. This
information is required for accurate
adjudication and processing of
beneficiary submitted claims. The claim
form is also instrumental in the
detection and prosecution of fraud. In
addition, the claim form is the only
mechanism to obtain, on an interim
basis, other health insurance (OHI)
information.
c. VA Form 10–7959c, CHAMPVA
Other Health Insurance (OHI)
Certification, is used to systematically
obtain OHI information and to correctly
coordinate benefits among all liable
parties. Except for Medicaid and health
insurance policies that are purchased
exclusively for the purpose of
supplementing CHAMPVA benefits,
CHAMPVA is always the secondary
payer of healthcare benefits (38 U.S.C.
501 and 1781, and 10 U.S.C. 1086).

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Federal Register / Vol. 89, No. 210 / Wednesday, October 30, 2024 / Notices

ddrumheller on DSK120RN23PROD with NOTICES1

d. VA Form 10–7959d, CHAMPVA
Potential Liability Claim, provides basic
information from which potential third
party liability can be assessed. The
Federal Medical Care Recovery Act (42
U.S.C. 2651–2653) mandates recovery of
costs associated with healthcare services
related to an injury/illness caused by a
third party. Additional authority
includes 38 U.S.C. 501; 38 CFR 1.900 et
seq.; 10 U.S.C. 1079 and 1086; 42 U.S.C.
2651–2653; and Executive Order 9397.
e. VA Form 10–7959e, VA Claim for
Miscellaneous Expenses, is used to
adjudicate claims for certain children of
Korea, Vietnam, and Thailand veterans
authorized under 38 U.S.C., chapter 18,
as amended by section 401, Public Law
106–419 and section 102, Public Law
108–183. VA’s medical regulations 38
CFR part 17 (17.900 through 17.905)
establish regulations regarding
provision of health care for certain
children of Korea, Vietnam, and
Thailand veterans and women Vietnam
veterans’ children born with spina
bifida and certain other covered birth
defects. These regulations also specify
the information to be included in
requests for preauthorization and claims
from approved health care providers.
f. Review and Appeal Process pertains
to the approval of health care, or
approval for payment relating to the
provision of health care, under the
Veteran Family Member Programs. The
provisions of the Veterans Appeals
Improvement and Modernization Act of
2017 (AMA, Pub. L. 115–55), chapter 51
of 38 U.S.C., or legacy claims under 38
CFR 17.277 and 38 CFR 17.904 establish

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a review process regarding
disagreements by an eligible beneficiary
of a Veteran Family Member Program,
provider, veteran, or other
representative of the veteran or
beneficiary, with a determination
concerning provision of health care or a
health care provider’s disagreement
with a determination regarding
payment. The person or entity
requesting reconsideration of such
determination is required to submit
such a request in writing (including
electronic where available). If such
person or entity remains dissatisfied
with the determination, the person or
entity is permitted to submit a written
request for additional review (VHA
Notice 2024–07).
g. Clinical Review pertains to the
requirement of VHA to preauthorize
certain medical services under 38 CFR
17.273 and 38 CFR 17.902. Clinical
review determines if services are
medically necessary and appropriate to
allow under the Veteran Family Member
Programs. The person requesting the
services must submit medical
documentation or applicable supporting
material for review.
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 89 FR
70692, August 30, 2024.
Affected Public: Individuals or
Households.

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Estimated Annual Burden: 37,867
total hours.
VA Form 10–10d—8,963 hours.
VA Form 10–7959a—12,486 hours.
VA Form 10–7959c—8,947 hours.
VA Form 10–7959d—239 hours.
VA Form 10–7959e—200 hours.
Review and Appeal Process—6,255
hours.
Clinical Review—777 hours.
Estimated Average Burden per
Respondent:
VA Form 10–10d—10 minutes.
VA Form 10–7959a—10 minutes.
VA Form 10–7959c—10 minutes.
VA Form 10–7959d—7 minutes.
VA Form 10–7959e—15 minutes.
Review and Appeal Process—30
minutes.
Clinical Review—20 minutes.
Frequency of Response: Once
annually.
Estimated Number of Respondents:
200,056 total.
VA Form 10–10d—53,775.
VA Form 10–7959a—74,914.
VA Form 10–7959c—53,680.
VA Form 10–7959d—2,045.
VA Form 10–7959e—800.
Review and Appeal Process—12,510.
Clinical Review—2,332.
Authority: 44 U.S.C. 3501 et seq.
Maribel Aponte,
VA PRA Clearance Officer, Office of
Enterprise and Integration, Data Governance
Analytics, Department of Veterans Affairs.
[FR Doc. 2024–24926 Filed 10–29–24; 8:45 am]
BILLING CODE 8320–01–P

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