81 FR 8129 - Proposed Information Collection (Disability Benefits Questionnaire (Group 3)); Activity: Comment Request
DEPARTMENT OF VETERANS AFFAIRS Federal Register Volume 81, Issue 31 (February 17, 2016)
Federal Register Volume 81, Issue 31 (February 17, 2016)
| Page Range | 8129-8130 | |
| FR Document | 2016-03207 |
[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)] [Notices] [Pages 8129-8130] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-03207] ----------------------------------------------------------------------- DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0778] Proposed Information Collection (Disability Benefits Questionnaire (Group 3)); Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: The Veterans Benefits Administration (VBA), 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 proposed revision of a currently approved collection, and allow 60 days for public comment in response to the notice. The VA Form 21-0960 series will be used to gather necessary information from a claimant's treating physician regarding the results of medical examinations. VA will gather medical information related to the claimant that is necessary to adjudicate the claim for VA disability benefits. The DBQ title will include the name of the specific disability for which it will gather information. VAF 21-0960C- 5, Central Nervous System and Neuromusculo Diseases Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of a central nervous system disease; VAF 21-0960C-8, Headaches (Including Migraine Headaches) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of headaches; VAF 21-0960C-9, Multiple Sclerosis (MS) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of multiple sclerosis; VAF 21-0960G-1, Esophageal Disorders (including GERD, Hiatal Hernia, and Other Esophageal Disorders) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any esophageal disorders; VAF 21-0960G-2, Gall Bladder and Pancreas Conditions Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any gall bladder and pancreas condition; VAF 21-0960G-3, Intestinal Conditions (Other than Surgical or Infectious) Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and Diverticulitis Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any intestinal conditions unrelated to surgery or infection; VAF 21-0960G-4, Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any infectious intestinal condition; VAF 21-0960G-5, Hepatitis, Cirrhosis and other Liver Conditions Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any liver condition; VAF 21-0960G-6, Peritoneal Adhesions Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of peritoneal adhesions; VAF 21-0960G-7, Stomach and Duodenum Conditions (Not Including GERD or Esophageal Disorders) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any stomach or duodenum conditions; VAF 21- 0960G-8, Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any surgical intestinal condition; VAF 21- 0960H-2, Rectum and Anus Conditions (Including Hemorrhoids) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of any rectum or [[Page 8130]] anus condition, which includes hemorrhoids; VAF 21-0960K-1 Breast Conditions and Disorders Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of a breast condition or disorder; VAF 21-0960K-2 Gynecological Conditions Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of a gynecological condition; VAF 21-0960L-2, Sleep Apnea Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of sleep apnea; VAF 21-0960M-11, Osteomyelitis Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of osteomyelitis; VAF 21-0960N-1, Ear Conditions (Including Vestibular and Infectious) Disability Benefits Questionnaire, will gather information related to the claimant's diagnosis of an ear disease. DATES: Written comments and recommendations on the proposed collection of information should be received on or before April 18, 2016. ADDRESSES: Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email to [email protected]. Please refer to ``OMB Control No. 2900-0778'' in any correspondence. FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 or FAX (202) 632-8925. SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 U.S.C. 3501-21), 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, VBA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VBA's functions, including whether the information will have practical utility; (2) the accuracy of VBA'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. Title: Disability Benefits Questionnaires (Group 3). OMB Control Number: 2900-0778. Type of Review: Revision of a currently approved collection. Abstract: The VA Form 21-0960 series will be used to gather necessary information from a claimant's treating physician regarding the results of medical examinations. VA will gather medical information related to the claimant that is necessary to adjudicate the claim for VA disability benefits. Affected Public: Individuals or households. Estimated Annual Burden: 77,500. Estimated Average Burden per Respondent i. VAF 21-0960C-5--30 minutes ii. VAF 21-0960C-8--15 minutes iii. VAF 21-0960C-9--45 minutes iv. VAF 21-0960G-1--15 minutes v. VAF 21-0960G-2--15 minutes vi. VAF 21-0960G-3--15 minutes vii. VAF 21-0960G-4--15 minutes viii. VAF 21-0960G-5--30 minutes ix. VAF 21-0960G-6--15 minutes x. VAF 21-0960G-7--15 minutes xi. VAF 21-0960G-8--15 minutes xii. VAF 21-0960H-2--15 minutes xiii. VAF 21-0960K-1--15 minutes xiv. VAF 21-0960K-2--30 minutes xv. VAF 21-0960L-2--15 minutes xvi. VAF 21-0960M-11--15 minutes xvii. VAF 21-0960N-1--15 minutes Frequency of Response: One time. Estimated Number of Respondents: 250,000. 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. 2016-03207 Filed 2-16-16; 8:45 am] BILLING CODE 8320-01-P
![Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices 8129
or other diseases of the nose, throat, Estimated Average Burden per information. VAF 21–0960C–5, Central
larynx, or pharynx; VAF 21–0960Q–1, Respondent Nervous System and Neuromusculo
Chronic Fatigue Syndrome Disability i. VAF 21–0960C–3—30 minutes Diseases Disability Benefits
Benefits Questionnaire, will gather ii. VAF 21–0960C–6—15 minutes Questionnaire, will gather information
information related to the claimant’s iii. VAF 21–0960C–7—15 minutes related to the claimant’s diagnosis of a
diagnosis of chronic fatigue syndrome. iv. VAF 21–0960C–11—15 minutes central nervous system disease; VAF
DATES: Written comments and v. VAF 21–0960D–1—15 minutes 21–0960C–8, Headaches (Including
recommendations on the proposed vi. VAF 21–0960E–2—15 minutes Migraine Headaches) Disability Benefits
collection of information should be vii. VAF 21–0960E–3—15 minutes Questionnaire, will gather information
received on or before April 18, 2016. viii. VAF 21–0960H–1—15 minutes related to the claimant’s diagnosis of
ADDRESSES: Submit written comments ix. VAF 21–0960I–2—15 minutes headaches; VAF 21–0960C–9, Multiple
on the collection of information through x. VAF 21–0960I–3—15 minutes Sclerosis (MS) Disability Benefits
Federal Docket Management System xi. VAF 21–0960I–4—30 minutes Questionnaire, will gather information
(FDMS) at www.Regulations.gov or to xii. VAF 21–0960I–5—15 minutes related to the claimant’s diagnosis of
Nancy J. Kessinger, Veterans Benefits xiii. VAF 21–0960J–4—15 minutes multiple sclerosis; VAF 21–0960G–1,
Administration (20M33), Department of xiv. VAF 21–0960L–1—30 minutes Esophageal Disorders (including GERD,
Veterans Affairs, 810 Vermont Avenue xv. VAF 21–0960N–3—15 minutes Hiatal Hernia, and Other Esophageal
NW., Washington, DC 20420 or email to xvi. VAF 21–0960N–4—30 minutes Disorders) Disability Benefits
nancy.kessinger@va.gov. Please refer to xvii. VAF 21–0960Q–1—15 minutes Questionnaire, will gather information
‘‘OMB Control No. 2900–0781’’ in any Frequency of Response: One time. related to the claimant’s diagnosis of
correspondence. Estimated Number of Respondents: any esophageal disorders; VAF 21–
160,000. 0960G–2, Gall Bladder and Pancreas
FOR FURTHER INFORMATION CONTACT: Conditions Disability Benefits
Nancy J. Kessinger at (202) 632–8924 or By direction of the Secretary.
Kathleen M. Manwell, Questionnaire, will gather information
FAX (202) 632–8925. related to the claimant’s diagnosis of
Program Analyst, VA Privacy Service, Office
SUPPLEMENTARY INFORMATION: Under the any gall bladder and pancreas
of Privacy and Records Management,
PRA of 1995 (Pub. L. 104–13; 44 U.S.C. Department of Veterans Affairs. condition; VAF 21–0960G–3, Intestinal
3501–21), Federal agencies must obtain Conditions (Other than Surgical or
[FR Doc. 2016–03206 Filed 2–16–16; 8:45 am]
approval from the Office of Management Infectious) Including Irritable Bowel
BILLING CODE 8320–01–P
and Budget (OMB) for each collection of Syndrome, Crohn’s Disease, Ulcerative
information they conduct or sponsor. Colitis, and Diverticulitis Disability
This request for comment is being made DEPARTMENT OF VETERANS Benefits Questionnaire, will gather
pursuant to Section 3506(c)(2)(A) of the AFFAIRS information related to the claimant’s
PRA. diagnosis of any intestinal conditions
With respect to the following [OMB Control No. 2900–0778] unrelated to surgery or infection; VAF
collection of information, VBA invites 21–0960G–4, Infectious Intestinal
comments on: (1) Whether the proposed Proposed Information Collection Disorders (including Bacterial and
collection of information is necessary (Disability Benefits Questionnaire Parasitic Infections) Disability Benefits
for the proper performance of VBA’s (Group 3)); Activity: Comment Request Questionnaire, will gather information
functions, including whether the AGENCY: Veterans Benefits related to the claimant’s diagnosis of
information will have practical utility; Administration, Department of Veterans any infectious intestinal condition; VAF
(2) the accuracy of VBA’s estimate of the Affairs. 21–0960G–5, Hepatitis, Cirrhosis and
burden of the proposed collection of ACTION: Notice. other Liver Conditions Disability
information; (3) ways to enhance the Benefits Questionnaire, will gather
quality, utility, and clarity of the SUMMARY: The Veterans Benefits information related to the claimant’s
information to be collected; and (4) Administration (VBA), Department of diagnosis of any liver condition; VAF
ways to minimize the burden of the Veterans Affairs (VA), is announcing an 21–0960G–6, Peritoneal Adhesions
collection of information on opportunity for public comment on the Disability Benefits Questionnaire, will
respondents, including through the use proposed collection of certain gather information related to the
of automated collection techniques or information by the agency. Under the claimant’s diagnosis of peritoneal
the use of other forms of information Paperwork Reduction Act (PRA) of adhesions; VAF 21–0960G–7, Stomach
technology. 1995, Federal agencies are required to and Duodenum Conditions (Not
Title: Disability Benefits publish notice in the Federal Register Including GERD or Esophageal
Questionnaires (Group 4). concerning each proposed collection of Disorders) Disability Benefits
OMB Control Number: 2900–0781. information, including each proposed Questionnaire, will gather information
Type of Review: Revision of a revision of a currently approved related to the claimant’s diagnosis of
currently approved collection. collection, and allow 60 days for public any stomach or duodenum conditions;
Abstract: The VA Form 21–0960 comment in response to the notice. VAF 21–0960G–8, Intestinal Surgery
series will be used to gather necessary The VA Form 21–0960 series will be (Bowel Resection, Colostomy,
information from a claimant’s treating used to gather necessary information Ileostomy) Disability Benefits
asabaliauskas on DSK5VPTVN1PROD with NOTICES
physician regarding the results of from a claimant’s treating physician Questionnaire, will gather information
medical examinations. VA will gather regarding the results of medical related to the claimant’s diagnosis of
medical information related to the examinations. VA will gather medical any surgical intestinal condition; VAF
claimant that is necessary to adjudicate information related to the claimant that 21–0960H–2, Rectum and Anus
the claim for VA disability benefits. is necessary to adjudicate the claim for Conditions (Including Hemorrhoids)
Affected Public: Individuals or VA disability benefits. The DBQ title Disability Benefits Questionnaire, will
households. will include the name of the specific gather information related to the
Estimated Annual Burden: 53,750. disability for which it will gather claimant’s diagnosis of any rectum or
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![8130 Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices
anus condition, which includes the use of other forms of information Administration (VBA), Department of
hemorrhoids; VAF 21–0960K–1 Breast technology. Veterans Affairs, will submit the
Conditions and Disorders Disability Title: Disability Benefits collection of information abstracted
Benefits Questionnaire, will gather Questionnaires (Group 3). below to the Office of Management and
information related to the claimant’s OMB Control Number: 2900–0778. Budget (OMB) for review and comment.
diagnosis of a breast condition or Type of Review: Revision of a The PRA submission describes the
disorder; VAF 21–0960K–2 currently approved collection. nature of the information collection and
Gynecological Conditions Disability Abstract: The VA Form 21–0960 its expected cost and burden; it includes
Benefits Questionnaire, will gather series will be used to gather necessary the actual data collection instrument.
information related to the claimant’s information from a claimant’s treating DATES: Comments must be submitted on
diagnosis of a gynecological condition; physician regarding the results of or before March 18, 2016.
VAF 21–0960L–2, Sleep Apnea medical examinations. VA will gather ADDRESSES: Submit written comments
Disability Benefits Questionnaire, will medical information related to the on the collection of information through
gather information related to the claimant that is necessary to adjudicate www.Regulations.gov, or to Office of
claimant’s diagnosis of sleep apnea; the claim for VA disability benefits. Information and Regulatory Affairs,
VAF 21–0960M–11, Osteomyelitis Affected Public: Individuals or Office of Management and Budget, Attn:
Disability Benefits Questionnaire, will households. VA Desk Officer; 725 17th St. NW.,
gather information related to the Estimated Annual Burden: 77,500. Washington, DC 20503 or sent through
claimant’s diagnosis of osteomyelitis; electronic mail to oira_submission@
Estimated Average Burden per
VAF 21–0960N–1, Ear Conditions omb.eop.gov. Please refer to ‘‘OMB
Respondent
(Including Vestibular and Infectious) Control No. 2900–0745’’ in any
Disability Benefits Questionnaire, will i. VAF 21–0960C–5—30 minutes correspondence.
gather information related to the ii. VAF 21–0960C–8—15 minutes
claimant’s diagnosis of an ear disease. iii. VAF 21–0960C–9—45 minutes FOR FURTHER INFORMATION CONTACT:
iv. VAF 21–0960G–1—15 minutes Crystal Rennie, Enterprise Records
DATES: Written comments and
v. VAF 21–0960G–2—15 minutes Service (005R1B), Department of
recommendations on the proposed Veterans Affairs, 810 Vermont Avenue
collection of information should be vi. VAF 21–0960G–3—15 minutes
vii. VAF 21–0960G–4—15 minutes NW., Washington, DC 20420, (202) 632–
received on or before April 18, 2016. 7492 or email crystal.rennie@va.gov.
viii. VAF 21–0960G–5—30 minutes
ADDRESSES: Submit written comments Please refer to ‘‘OMB Control No. 2900–
ix. VAF 21–0960G–6—15 minutes
on the collection of information through x. VAF 21–0960G–7—15 minutes 0745.’’
Federal Docket Management System xi. VAF 21–0960G–8—15 minutes SUPPLEMENTARY INFORMATION:
(FDMS) at www.Regulations.gov or to xii. VAF 21–0960H–2—15 minutes Title: Request for Certificate of
Nancy J. Kessinger, Veterans Benefits xiii. VAF 21–0960K–1—15 minutes Veteran Status.
Administration (20M33), Department of xiv. VAF 21–0960K–2—30 minutes OMB Control Number: 2900–0745.
Veterans Affairs, 810 Vermont Avenue xv. VAF 21–0960L–2—15 minutes Type of Review: Revision of a
NW., Washington, DC 20420 or email to xvi. VAF 21–0960M–11—15 minutes currently approved collection.
nancy.kessinger@va.gov. Please refer to xvii. VAF 21–0960N–1—15 minutes Abstract: Applicants complete VA
‘‘OMB Control No. 2900–0778’’ in any form 26–8621a to apply for a position as
correspondence. Frequency of Response: One time.
a designate fee appraiser or compliance
Estimated Number of Respondents:
FOR FURTHER INFORMATION CONTACT: inspector. VA will use the data collected
250,000.
Nancy J. Kessinger at (202) 632–8924 or to determine the applicant’s experience
By direction of the Secretary. in the real estate valuation field.
FAX (202) 632–8925.
Kathleen M. Manwell, An agency may not conduct or
SUPPLEMENTARY INFORMATION: Under the
Program Analyst, VA Privacy Service, Office sponsor, and a person is not required to
PRA of 1995 (Pub. L. 104–13; 44 U.S.C. of Privacy and Records Management, respond to a collection of information
3501–21), Federal agencies must obtain Department of Veterans Affairs. unless it displays a currently valid OMB
approval from the Office of Management [FR Doc. 2016–03207 Filed 2–16–16; 8:45 am] control number. The Federal Register
and Budget (OMB) for each collection of BILLING CODE 8320–01–P Notice with a 60-day comment period
information they conduct or sponsor. soliciting comments on this collection
This request for comment is being made of information was published at 80 FR
pursuant to Section 3506(c)(2)(A) of the DEPARTMENT OF VETERANS 63879 on October 21, 2015.
PRA. AFFAIRS Title: Request for Certificate of
With respect to the following Veteran Status.
collection of information, VBA invites [OMB Control No. 2900–0745]
OMB Control Number: 2900–0745.
comments on: (1) Whether the proposed Type of Review: Revision of a
Agency Information Collection
collection of information is necessary currently approved collection.
(Application for Fee or Roster
for the proper performance of VBA’s Abstract: Applicants complete VA
Personnel Designation) Activity Under
functions, including whether the form 26–8621a to apply for a position as
OMB Review
information will have practical utility; a designate fee appraiser or compliance
(2) the accuracy of VBA’s estimate of the Veterans Benefits
asabaliauskas on DSK5VPTVN1PROD with NOTICES
AGENCY: inspector. VA will use the data collected
burden of the proposed collection of Administration, Department of Veterans to determine the applicant’s experience
information; (3) ways to enhance the Affairs. in the real estate valuation field.
quality, utility, and clarity of the ACTION: Notice. Affected Public: Individuals or
information to be collected; and (4) households.
ways to minimize the burden of the SUMMARY: In compliance with the Estimated Annual Burden: 4 hours.
collection of information on Paperwork Reduction Act (PRA) of 1995 Estimated Average Burden per
respondents, including through the use (44 U.S.C. 3501–3521), this notice Respondent: 10 minutes.
of automated collection techniques or announces that the Veterans Benefits Frequency of Response: One-time.
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Document Created: 2016-02-17 01:16:14
Document Modified: 2016-02-17 01:16:14
| 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 April 18, 2016. | |
| Contact | Nancy J. Kessinger at (202) 632-8924 or FAX (202) 632-8925. | |
| FR Citation | 81 FR 8129 |
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