81 FR 33738 - Proposed Information Collection Activity; Comment Request (Expanded Access to Non-VA Care Through the Veterans Choice Program)

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 81, Issue 103 (May 27, 2016)

Page Range		33738-33739
FR Document		2016-12574

The Veterans Health Administration (VHA), 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 extension collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on the information needed for Veterans, Veteran Representatives and health care providers to request reimbursement from the federal government for emergency services at a private institution.

Federal Register, Volume 81 Issue 103 (Friday, May 27, 2016)

[Federal Register Volume 81, Number 103 (Friday, May 27, 2016)]
[Notices]
[Pages 33738-33739]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-12574]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0823]


Proposed Information Collection Activity; Comment Request 
(Expanded Access to Non-VA Care Through the Veterans Choice Program)

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA), 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 extension 
collection, and allow 60 days for public comment in response to the 
notice. This notice solicits comments on the information needed for 
Veterans, Veteran Representatives and health care providers to request 
reimbursement from the federal government for emergency services at a 
private institution.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 26, 2016.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov; 
or 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. 2900-0823'' 
in any correspondence. During the comment period, comments may be 
viewed online through the 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 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 comments on: (1) Whether the proposed

[[Page 33739]]

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: Election to Receive Authorized Non-VA Care and Selection of 
Provider for the Veterans Choice Program (VA Form 10-10143).
    OMB Control Number: 2900-0823.
    Type of Review: Extension.
    Abstract: Section 17.1515 requires eligible veterans to notify VA 
whether the veteran elects to receive authorized non-VA care through 
the Veterans Choice Program, be placed on an electronic waiting list, 
or be scheduled for an appointment with a VA health care provider. 
Section 17.1515(b)(1) also allows eligible veterans to specify a 
particular non-VA entity or health care provider, if that entity or 
provider meets certain requirements.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 928,606 burden hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: 12.64 times per year.
    Estimated Number of Respondents: 440,794 respondents.

    Titles: Health-Care Plan Information for the Veterans Choice 
Program (VA Form 10-10143a).
    OMB Control Number: 2900-0823.
    Type of Review: Extension.
    Abstract: Section 17.1510(d) requires eligible veterans to submit 
to VA information about their health-care plan to participate in the 
Veterans Choice Program.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 88,159 burden hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: 1.2 times per year.
    Estimated Number of Respondents: 440,794 respondents.

    Titles: Submission of Medical Record Information Under the Veterans 
Choice Program (VA Form 10-10143b).
    OMB Control Number: 2900-0823.
    Type of Review: Extension.
    Abstract: Participating eligible entities and providers are 
required to submit a copy of any medical record related to hospital 
care or medical services furnished under this Program to an eligible 
veteran.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 464,428 burden hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: 29.80 times per year.
    Estimated Number of Respondents: 187,000 respondents.

    Titles: Submission of Information on Credentials and Licenses by 
Eligible Entities or Providers (VA Form 10-10143c).
    OMB Control Number: 2900-0823.
    Type of Review: Extension.
    Abstract: Section 17.1530 requires eligible entities and providers 
to submit verification that the entity or provider maintains at least 
the same or similar credentials and licenses as those required of VA's 
health care providers, as determined by the Secretary.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 15,583 burden hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 187,000 respondents.

    Titles: Secondary Authorization Request for VA Community Care (VA 
Form 10-10143e).
    OMB Control Number: 2900-0823.
    Type of Review: New.
    Abstract: VA Form 10-10143e would require non-VA health care 
providers to submit requests for additional services supporting the 
original authorized plan of care to the agency. 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 this Program must be submitted to VA 
for entry into the veteran's electronic medical record. Providers will 
be required to submit records produced as a result of care authorized 
after the beginning of the Program.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 289,826 burden hours.
    Estimated Average Burden per Respondent: 20 minutes.
    Frequency of Response: 4.56 times per year.
    Estimated Number of Respondents: 190,675 respondents.

    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. 2016-12574 Filed 5-26-16; 8:45 am]
BILLING CODE 8320-01-P

33738 Federal Register / Vol. 81, No. 103 / Friday, May 27, 2016 / Notices

Estimated Total Annual Burden required by law (22 U.S.C. 286f; 22 DEPARTMENT OF VETERANS
Hours: 1. U.S.C. 3103; E.O. 10033; 31 CFR part AFFAIRS
Brenda Simms,
128), and is designed to collect timely
[OMB Control No. 2900–0823]
information on international portfolio
Treasury PRA Clearance Officer.
capital movements. Forms CQ–1 and Proposed Information Collection
[FR Doc. 2016–12626 Filed 5–26–16; 8:45 am]
CQ–2 are quarterly reports filed by non- Activity; Comment Request (Expanded
BILLING CODE 4810–31–P
financial enterprises in the U.S. to Access to Non-VA Care Through the
report their international portfolio Veterans Choice Program)
DEPARTMENT OF THE TREASURY transactions with unaffiliated foreign
residents. This information is necessary AGENCY: Veterans Health
Proposed Collections; Comment for compiling the U.S. balance of Administration, Department of Veterans
Requests payments accounts and the U.S. Affairs.
international investment position, and ACTION: Notice.
AGENCY: Departmental Offices;
Department of the Treasury. for use in formulating U.S. international
SUMMARY: The Veterans Health
financial and monetary policies. Administration (VHA), Department of
ACTION: Notice and request for
comments. Current Actions: No changes are Veterans Affairs (VA), is announcing an
proposed at this time. opportunity for public comment on the
SUMMARY: The Department of the proposed collection of certain
Type of Review: Extension of a
Treasury, as part of its continuing effort information by the agency. Under the
to reduce paperwork burdens, invites currently approved data collection.
Paperwork Reduction Act (PRA) of
the general public and other Federal Affected Public: Business or other for- 1995, Federal agencies are required to
agencies to comment on revisions of an profit organizations. publish notice in the Federal Register
information collection that are proposed Forms: CQ–1 and CQ–2 (1505–0024). concerning each proposed collection of
for approval by the Office of information, including each extension
Management and Budget. The Office of Estimated Number of Respondents:
148. collection, and allow 60 days for public
International Affairs within the comment in response to the notice. This
Department of the Treasury is soliciting Estimated Average Time per notice solicits comments on the
comments concerning Treasury Respondent: Six and nine-tenths (6.9) information needed for Veterans,
International Capital Forms CQ–1 and hours per respondent per filing. This Veteran Representatives and health care
CQ–2, ‘‘Financial and Commercial average time varies from 13 hours for providers to request reimbursement
Liabilities to, and Claims on, the approximately 12 major data from the federal government for
Unaffiliated Foreign Residents.’’ reporters to 6.5 hours for the other emergency services at a private
DATES: Written comments should be reporters. institution.
received on or before July 26, 2016 to be Estimated Total Annual Burden
assured of consideration. DATES: Written comments and
Hours: 4,085 hours, based on 4 reporting recommendations on the proposed
ADDRESSES: Direct all written comments periods per year. collection of information should be
to Dwight Wolkow, International received on or before July 26, 2016.
Portfolio Investment Data Systems, Request For Comments: Comments
Department of the Treasury, Room 5422, submitted in response to this notice will ADDRESSES: Submit written comments
1500 Pennsylvania Avenue NW., be summarized and/or included in the on the collection of information through
Washington, DC 20220. In view of request for Office of Management and Federal Docket Management System
possible delays in mail delivery, please Budget approval. All comments will (FDMS) at www.Regulations.gov; or
also notify Mr. Wolkow by email become a matter of public record. The Brian McCarthy, Office of Regulatory
(comments2TIC@treasury.gov), fax public is invited to submit written and Administrative Affairs, Veterans
(202–622–2009) or telephone (202–622– comments concerning: (a) Whether Health Administration (10B4),
1276). Forms CQ–1 and CQ–2 are necessary for Department of Veterans Affairs, 810
the proper performance of the functions Vermont Avenue NW., Washington, DC
FOR FURTHER INFORMATION CONTACT:
of the Office, including whether the 20420 or email: Brian.McCarthy4@
Copies of the proposed forms and
information will have practical uses; (b) va.gov. Please refer to ‘‘OMB Control
instructions are available on the
the accuracy of the above estimate of the No. 2900–0823’’ in any correspondence.
Treasury’s TIC Web page for forms,
burdens; (c) ways to enhance the During the comment period, comments
http://www.treasury.gov/resource-
quality, usefulness and clarity of the may be viewed online through the
center/data-chart-center/tic/Pages/
information to be collected; (d) ways to FDMS.
forms.aspx. Requests for additional
information should be directed to Mr. minimize the reporting and/or record FOR FURTHER INFORMATION CONTACT:
Wolkow. keeping burdens on respondents, Brian McCarthy at (202) 461–6345.
SUPPLEMENTARY INFORMATION: including the use of information SUPPLEMENTARY INFORMATION: Under the
Title: Treasury International Capital technologies to automate the collection PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
Form CQ–1, ‘‘Financial Liabilities to, of the data; and (e) estimates of capital 3501–3521), Federal agencies must
and Claims on, Unaffiliated Foreign or start-up costs of operation, obtain approval from the Office of
maintenance and purchase of services to Management and Budget (OMB) for each
sradovich on DSK3TPTVN1PROD with NOTICES

Residents;’’ and Treasury International
Capital Form CQ–2, ‘‘Commercial provide information. collection of information they conduct
Liabilities to, and Claims on, or sponsor. This request for comment is
Dwight Wolkow, being made pursuant to Section
Unaffiliated Foreign Residents.’’
OMB Number: 1505–0024. Administrator, International Portfolio 3506(c)(2)(A) of the PRA.
Abstract: Forms CQ–1 and CQ–2 are Investment Data Systems. With respect to the following
part of the Treasury International [FR Doc. 2016–12273 Filed 5–26–16; 8:45 am] collection of information, VHA invites
Capital (TIC) reporting system, which is BILLING CODE 4810–25–P comments on: (1) Whether the proposed

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Federal Register / Vol. 81, No. 103 / Friday, May 27, 2016 / Notices 33739

collection of information is necessary information about their health-care plan Estimated Annual Burden: 15,583
for the proper performance of VHA’s to participate in the Veterans Choice burden hours.
functions, including whether the Program. Estimated Average Burden per
information will have practical utility; Affected Public: Individuals or Respondent: 5 minutes.
(2) the accuracy of VHA’s estimate of Households. Frequency of Response: Once
the burden of the proposed collection of Estimated Annual Burden: 88,159 annually.
information; (3) ways to enhance the burden hours.
quality, utility, and clarity of the Estimated Average Burden per Estimated Number of Respondents:
information to be collected; and (4) Respondent: 10 minutes. 187,000 respondents.
ways to minimize the burden of the Frequency of Response: 1.2 times per Titles: Secondary Authorization
collection of information on year. Request for VA Community Care (VA
respondents, including through the use Estimated Number of Respondents: Form 10–10143e).
of automated collection techniques or 440,794 respondents. OMB Control Number: 2900–0823.
the use of other forms of information Titles: Submission of Medical Record Type of Review: New.
technology. Information Under the Veterans Choice
Titles: Election to Receive Authorized Abstract: VA Form 10–10143e would
Program (VA Form 10–10143b).
Non-VA Care and Selection of Provider require non-VA health care providers to
OMB Control Number: 2900–0823.
for the Veterans Choice Program (VA submit requests for additional services
Type of Review: Extension.
Form 10–10143). supporting the original authorized plan
Abstract: Participating eligible entities
OMB Control Number: 2900–0823. of care to the agency. A copy of all
and providers are required to submit a
Type of Review: Extension. medical and dental records (including
copy of any medical record related to
Abstract: Section 17.1515 requires but not limited to images, test results,
hospital care or medical services
eligible veterans to notify VA whether and notes or other records of what care
furnished under this Program to an
the veteran elects to receive authorized was provided and why) related to a
eligible veteran.
non-VA care through the Veterans Affected Public: Individuals or Veteran’s care provided under this
Choice Program, be placed on an Households. Program must be submitted to VA for
electronic waiting list, or be scheduled Estimated Annual Burden: 464,428 entry into the veteran’s electronic
for an appointment with a VA health burden hours. medical record. Providers will be
care provider. Section 17.1515(b)(1) also Estimated Average Burden per required to submit records produced as
allows eligible veterans to specify a Respondent: 5 minutes. a result of care authorized after the
particular non-VA entity or health care Frequency of Response: 29.80 times beginning of the Program.
provider, if that entity or provider meets per year. Affected Public: Individuals or
certain requirements. Estimated Number of Respondents: Households.
Affected Public: Individuals or 187,000 respondents. Estimated Annual Burden: 289,826
Households.
Estimated Annual Burden: 928,606 Titles: Submission of Information on burden hours.
burden hours. Credentials and Licenses by Eligible Estimated Average Burden per
Estimated Average Burden per Entities or Providers (VA Form 10– Respondent: 20 minutes.
Respondent: 10 minutes. 10143c). Frequency of Response: 4.56 times per
Frequency of Response: 12.64 times OMB Control Number: 2900–0823. year.
per year. Type of Review: Extension. Estimated Number of Respondents:
Estimated Number of Respondents: Abstract: Section 17.1530 requires
190,675 respondents.
440,794 respondents. eligible entities and providers to submit
verification that the entity or provider By direction of the Secretary.
Titles: Health-Care Plan Information
for the Veterans Choice Program (VA maintains at least the same or similar Kathleen M. Manwell,
Form 10–10143a). credentials and licenses as those Program Analyst, VA Privacy Service, Office
OMB Control Number: 2900–0823. required of VA’s health care providers, of Privacy and Records Management,
Type of Review: Extension. as determined by the Secretary. Department of Veterans Affairs.
Abstract: Section 17.1510(d) requires Affected Public: Individuals or [FR Doc. 2016–12574 Filed 5–26–16; 8:45 am]
eligible veterans to submit to VA Households. BILLING CODE 8320–01–P
sradovich on DSK3TPTVN1PROD with NOTICES

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Document Created: 2018-02-07 15:10:17
Document Modified: 2018-02-07 15:10:17

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 July 26, 2016.
Contact		Brian McCarthy at (202) 461-6345.
FR Citation		81 FR 33738