80 FR 46104 - Proposed Information Collection (Foreign Medical Program Application and Claim Cover Sheet) Activity: Comment Request

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 80, Issue 148 (August 3, 2015)

Page Range		46104-46105
FR Document		2015-18925

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.

Federal Register, Volume 80 Issue 148 (Monday, August 3, 2015)

[Federal Register Volume 80, Number 148 (Monday, August 3, 2015)]
[Notices]
[Pages 46104-46105]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-18925]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0648]


Proposed Information Collection (Foreign Medical Program 
Application and Claim Cover Sheet) 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 October 2, 2015.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and 
Administrative Affairs, Veterans Health Administration (10B4), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420 or email: [email protected]. Please refer to ``OMB Control 
No. 2900-0648'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461-6345.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 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. Foreign Medical Program (FMP) Registration Form.
    2. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP).
    OMB Control Number: 2900-0648.
    Type of Review: Extension of a currently approved collection.
    Abstracts: This information collection is needed to carry out the 
health care benefits allowed by the Foreign Medical Program (FMP). It 
is a federal health benefits program for Veterans administered by the 
Department of Veterans Affairs (VA) Veterans Health Administration 
(VHA). FMP is a Fee for Service (indemnity plan) program. FMP provides 
reimbursement for VA adjudicated service-connected conditions. Title 38 
CFR 17.35 states that the VA will provide coverage for the Veteran's 
service-connected disability when the Veteran is residing or traveling 
overseas.
    VA Form 10-7959f-1, Foreign Medical Program (FMP) Registration 
Form, is used to register into the Foreign Medical Program those 
Veterans with service-connected disabilities that are living or 
traveling overseas. Title 38 CFR 17.125(d) states that requests for 
consideration of claim reimbursement from approved health care 
providers and Veterans are to be mailed to VHA Health Administration 
Center (HAC). The VA Form 10-7959f-2, Claim Cover Sheet--Foreign 
Medical Program streamlines the claims submission process for claimants 
or physicians while also reducing the time spent by VA on processing 
FMP claims. The cover sheet will allow foreign providers/Veterans with 
a better understanding of basic information required for the processing 
and payment of claims.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--111 hours.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--3,652 hours.
    Estimated Average Burden per Respondent:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--4 minutes.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--11 minutes.
    Frequency of Response:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--Annually
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2 --12 times a year.
    Estimated Annual Responses:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--1,660.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--19,920.


[[Page 46105]]


    By direction of the Secretary.
Kathleen M. Manwell,
Program Analyst, VA Privacy Service, Office of Privacy and Records 
Management, Department of Veterans Affairs.
[FR Doc. 2015-18925 Filed 7-31-15; 8:45 am]
BILLING CODE 8320-01-P

46104 Federal Register / Vol. 80, No. 148 / Monday, August 3, 2015 / Notices

approval from the Office of Management information by the agency. Under the Abstracts: This information collection
and Budget (OMB) for each collection of Paperwork Reduction Act (PRA) of is needed to carry out the health care
information they conduct or sponsor. 1995, Federal agencies are required to benefits allowed by the Foreign Medical
This request for comment is being made publish notice in the Federal Register Program (FMP). It is a federal health
pursuant to Section 3506(c)(2)(A) of the concerning each proposed collection of benefits program for Veterans
PRA. information, including each proposed administered by the Department of
With respect to the following extension of a currently approved Veterans Affairs (VA) Veterans Health
collection of information, VBA invites collection, and allow 60 days for public Administration (VHA). FMP is a Fee for
comments on: (1) Whether the proposed comment in response to the notice. This Service (indemnity plan) program. FMP
collection of information is necessary notice solicits comments on information provides reimbursement for VA
for the proper performance of VBA’s needed to identify areas for adjudicated service-connected
functions, including whether the improvement in clinical training conditions. Title 38 CFR 17.35 states
information will have practical utility; programs. that the VA will provide coverage for
(2) the accuracy of VBA’s estimate of the DATES: Written comments and the Veteran’s service-connected
burden of the proposed collection of recommendations on the proposed disability when the Veteran is residing
information; (3) ways to enhance the collection of information should be or traveling overseas.
quality, utility, and clarity of the received on or before October 2, 2015. VA Form 10–7959f–1, Foreign
information to be collected; and (4) Medical Program (FMP) Registration
ways to minimize the burden of the ADDRESSES: Submit written comments
Form, is used to register into the Foreign
collection of information on on the collection of information through Medical Program those Veterans with
respondents, including through the use the Federal Docket Management System service-connected disabilities that are
of automated collection techniques or (FDMS) at www.Regulations.gov; or to living or traveling overseas. Title 38
the use of other forms of information Brian McCarthy, Office of Regulatory CFR 17.125(d) states that requests for
technology. and Administrative Affairs, Veterans consideration of claim reimbursement
Title: Direct Deposit Enrollment; Health Administration (10B4), from approved health care providers
International Direct Deposit Enrollment Department of Veterans Affairs, 810 and Veterans are to be mailed to VHA
(24–0296 & 24–0296a). Vermont Avenue NW., Washington, DC Health Administration Center (HAC).
OMB Control Number: 2900–0564. 20420 or email: Brian.McCarthy4@ The VA Form 10–7959f–2, Claim Cover
Type of Review: Revision of a va.gov. Please refer to ‘‘OMB Control Sheet—Foreign Medical Program
currently approved collection. No. 2900–0648’’ in any correspondence. streamlines the claims submission
Abstract: The information collected During the comment period, comments process for claimants or physicians
on these forms will be used to enroll VA may be viewed online through FDMS. while also reducing the time spent by
benefit recipients in the electronic funds FOR FURTHER INFORMATION CONTACT: VA on processing FMP claims. The
transfer (EFT) program. Brian McCarthy at (202) 461–6345. cover sheet will allow foreign providers/
Estimated Annual Burden: 1,250 SUPPLEMENTARY INFORMATION: Under the Veterans with a better understanding of
hours. PRA of 1995 (Pub. L. 104–13; 44 U.S.C. basic information required for the
Estimated Average Burden per 3501–3521), Federal agencies must processing and payment of claims.
Respondent: 15 minutes. obtain approval from OMB for each Affected Public: Individuals or
Frequency of Response: On occasion. collection of information they conduct households.
Estimated Number of Respondents: or sponsor. This request for comment is Estimated Annual Burden:
5,000. being made pursuant to Section a. Foreign Medical Program (FMP)
By direction of the Secretary. 3506(c)(2)(A) of the PRA. Registration Form—fill, VA Form 10–
Kathleen M. Manwell, With respect to the following 7959f–1—111 hours.
Program Analyst, VA Privacy Service, Office
collection of information, VHA invites b. CLAIM COVER SHEET—FOREIGN
of Privacy and Records Management, comments on: (1) Whether the proposed MEDICAL PROGRAM (FMP)—fill, VA
Department of Veterans Affairs. collection of information is necessary Form 10–7959f–2—3,652 hours.
[FR Doc. 2015–18924 Filed 7–31–15; 8:45 am] for the proper performance of VHA’s Estimated Average Burden per
BILLING CODE 8320–01–P
functions, including whether the Respondent:
information will have practical utility; a. Foreign Medical Program (FMP)
(2) the accuracy of VHA’s estimate of Registration Form—fill, VA Form 10–
DEPARTMENT OF VETERANS the burden of the proposed collection of 7959f–1—4 minutes.
AFFAIRS information; (3) ways to enhance the b. CLAIM COVER SHEET—FOREIGN
quality, utility, and clarity of the MEDICAL PROGRAM (FMP)—fill, VA
[OMB Control No. 2900–0648] information to be collected; and (4) Form 10–7959f–2—11 minutes.
ways to minimize the burden of the Frequency of Response:
Proposed Information Collection collection of information on a. Foreign Medical Program (FMP)
(Foreign Medical Program Application respondents, including through the use Registration Form—fill, VA Form 10–
and Claim Cover Sheet) Activity: of automated collection techniques or 7959f–1—Annually
Comment Request the use of other forms of information b. CLAIM COVER SHEET—FOREIGN
AGENCY: Veterans Health technology. MEDICAL PROGRAM (FMP)—fill, VA
Titles:
mstockstill on DSK4VPTVN1PROD with NOTICES

Administration, Department of Veterans Form 10–7959f–2 —12 times a year.
Affairs. 1. Foreign Medical Program (FMP) Estimated Annual Responses:
ACTION: Notice. Registration Form. a. Foreign Medical Program (FMP)
2. CLAIM COVER SHEET—FOREIGN Registration Form—fill, VA Form 10–
SUMMARY: The Veterans Health MEDICAL PROGRAM (FMP). 7959f–1—1,660.
Administration (VHA) is announcing an OMB Control Number: 2900–0648. b. CLAIM COVER SHEET—FOREIGN
opportunity for public comment on the Type of Review: Extension of a MEDICAL PROGRAM (FMP)—fill, VA
proposed collection of certain currently approved collection. Form 10–7959f–2—19,920.

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Federal Register / Vol. 80, No. 148 / Monday, August 3, 2015 / Notices 46105

By direction of the Secretary. respond to a collection of information Audrey Revere, Office of Regulatory and
Kathleen M. Manwell, unless it displays a currently valid OMB Administrative Affairs, Veterans Health
Program Analyst, VA Privacy Service, Office control number. The Federal Register Administration (10B4), Department of
of Privacy and Records Management, Notice with a 60-day comment period Veterans Affairs, 810 Vermont Avenue
Department of Veterans Affairs. soliciting comments on this collection NW., Washington, DC 20420 or email:
[FR Doc. 2015–18925 Filed 7–31–15; 8:45 am] of information was published at 80 FR Audrey.revere@va.gov. Please refer to
BILLING CODE 8320–01–P 03446 on February 12, 2015. ‘‘OMB Control No. 2900–0090’’ in any
Affected Public: Individuals or correspondence. During the comment
households. period, comments may be viewed online
DEPARTMENT OF VETERANS Estimated Annual Burden: 2,000 through the FDMS.
AFFAIRS hours. FOR FURTHER INFORMATION CONTACT:
[OMB Control No. 2900–0784]
Estimated Average Burden per Audrey Revere at (202) 461–5694.
Respondent: 1 minute.
SUPPLEMENTARY INFORMATION: Under the
Proposed Information Collection (NCA Frequency of Response: One-time.
Estimated Number of Respondents: PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
PreNeed Burial Planning) 3501–3521), Federal agencies must
8,000.
AGENCY: National Cemetery obtain approval from the Office of
By direction of the Secretary. Management and Budget (OMB) for each
Administration, Department of Veterans
Affairs Kathleen M. Manwell, collection of information they conduct
Program Analyst, VA Privacy Service, Office or sponsor. This request for comment is
ACTION: Notice.
of Privacy and Records Management, being made pursuant to Section
SUMMARY: In compliance with the Department of Veterans Affairs. 3506(c)(2)(A) of the PRA.
Paperwork Reduction Act (PRA) of 1995 [FR Doc. 2015–18930 Filed 7–31–15; 8:45 am] With respect to the following
(44 U.S.C. 3501–3521), this notice BILLING CODE 8320–01–P collection of information, VHA invites
announces that the National Cemetery comments on: (1) Whether the proposed
Administration (NCA), Department of collection of information is necessary
Veterans Affairs, will submit the DEPARTMENT OF VETERANS for the proper performance of VHA’s
collection of information abstracted AFFAIRS functions, including whether the
below to the Office of Management and [OMB Control No. 2900–0090] information will have practical utility;
Budget (OMB) for review and comment. (2) the accuracy of VHA’s estimate of
The PRA submission describes the Proposed Information Collection the burden of the proposed collection of
nature of the information collection and (Application for Voluntary Service VA information; (3) ways to enhance the
its expected cost and burden; it includes Form 10–7055 and Associated Internet quality, utility, and clarity of the
the actual data collection instrument. Application) ; Activity: Comment information to be collected; and (4)
DATES: Comments must be submitted on Request ways to minimize the burden of the
or before September 2, 2015. collection of information on
AGENCY: Veterans Health
ADDRESSES: Submit written comments respondents, including through the use
Administration, Department of Veterans
on the collection of information through of automated collection techniques or
Affairs.
www.Regulations.gov, or to Office of the use of other forms of information
Information and Regulatory Affairs, ACTION: Notice. technology.
Office of Management and Budget, Attn: SUMMARY: The Veterans Health Titles: Application for Voluntary
VA Desk Officer; 725 17th St. NW., Administration (VHA), Department of Service VA Form 10–7055 and
Washington, DC 20503 or sent through Veterans Affairs (VA), is announcing an Associated Internet Application.
electronic mail to oira_submission@ opportunity for public comment on the OMB Control Number: 2900–0090.
omb.eop.gov. Please refer to ‘‘OMB proposed collection of certain Type of Review: Revision.
Control No. 2900–0784’’ in any information by the agency. Under the Abstract: This application (VA Form
correspondence. Paperwork Reduction Act (PRA) of 10–7055 and the associated web form)
FOR FURTHER INFORMATION CONTACT: 1995, Federal agencies are required to will be here-in-after referred to as the
Crystal Rennie, Enterprise Records publish notice in the Federal Register form. The form is used to assist
Service (005R1B), Department of concerning each proposed collection of personnel of volunteer organizations,
Veterans Affairs, 810 Vermont Avenue information, including each revised which recruit volunteers from their
NW., Washington, DC 20420, (202) 632– collection, and allow 60 days for public membership, and the Department of
7492 or email crystal.rennie@va.gov. comment in response to the notice. This Veterans Affairs (VA) in the selection,
Please refer to ‘‘OMB Control No. 2900– notice solicits comments on the screening and placement of volunteers
0784.’’ information needed for Veterans, in the nationwide VA Voluntary Service
SUPPLEMENTARY INFORMATION: Veteran Representatives and health care program. The volunteer program
Title: NCA PreNeed Burial Eligibility providers to request reimbursement supplements the medical care and
Planning, VA Form 40–10007. from the federal government for treatment of veteran patients in all VA
OMB Control Number: 2900–0784. emergency services at a private medical centers. This form is necessary
Type of Review: Revision of a institution. to assist in determining the suitability
currently approved collection. and placement of potential volunteers.
DATES: Written comments and
mstockstill on DSK4VPTVN1PROD with NOTICES

Abstract: VA Form Letter 40–10007 The information is collected under the
will be used to collect information from recommendations on the proposed authority of 38 U.S.C. 7405(a).
Veterans and service members with collection of information should be Affected Public: Individuals or
terminal illnesses and adult dependent received on or before October 2, 2015. Households.
children in hospitals and other ADDRESSES: Submit written comments Estimated Annual Burden: 8,000
institutions. on the collection of information through burden hours.
An agency may not conduct or Federal Docket Management System Estimated Average Burden per
sponsor, and a person is not required to (FDMS) at www.Regulations.gov; or Respondent: 15 minutes.

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Document Created: 2018-02-23 10:51:32
Document Modified: 2018-02-23 10:51:32

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice.
Dates		Written comments and recommendations on the proposed collection of information should be received on or before October 2, 2015.
Contact		Brian McCarthy at (202) 461-6345.
FR Citation		80 FR 46104