80 FR 48958 - Agency Information Collection (Foreign Medical Program Application and Claim Cover Sheet) Activities Under OMB Review

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 80, Issue 157 (August 14, 2015)

In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501-3521), 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 and includes the actual data collection instrument.

[Federal Register Volume 80, Number 157 (Friday, August 14, 2015)]
[Notices]
[Pages 48958-48959]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-19965]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0648]


Agency Information Collection (Foreign Medical Program 
Application and Claim Cover Sheet) Activities Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), 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 and includes the actual data collection instrument.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before September 14, 2015.

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 
[email protected]. Please refer to ``OMB Control No. 2900-
0648'' in any correspondence. During the comment period, comments may 
be viewed online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0648'' 
(Foreign Medical Program Application and Claim Cover Sheet) in any 
correspondence.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), 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, VHA 
invites

[[Page 48959]]

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.

SUPPLEMENTARY INFORMATION: 

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.

    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. 2015-19965 Filed 8-13-15; 8:45 am]
 BILLING CODE 8320-01-P