82 FR 19312 - Agency Information Collection Activity: Operation Enduring Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member Veteran Worksheet

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 79 (April 26, 2017)

Page Range		19312-19313
FR Document		2017-08438

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. VA Form 21-0773 is a checklist for Veterans Service Representatives to verify they have given information, applications, and/or referral service to our Operation Enduring Freedom or Operation Iraqi Freedom service members who have at least six months remaining on active duty and who may have suffered a serious injury or illness. This form will be maintained in the veteran's claims folder.

Federal Register, Volume 82 Issue 79 (Wednesday, April 26, 2017)

[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Pages 19312-19313]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-08438]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0720]


Agency Information Collection Activity: Operation Enduring 
Freedom/Operation Iraqi Freedom Seriously Injured/Ill Service Member 
Veteran Worksheet

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. VA Form 21-0773 is a checklist for Veterans 
Service Representatives to verify they have given information, 
applications, and/or referral service to our Operation Enduring Freedom 
or Operation Iraqi Freedom service members who have at least six months 
remaining on active duty and who may have suffered a serious injury or 
illness. This form will be maintained in the veteran's claims folder.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before June 26, 2017.

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. 2900-0720 '' in any correspondence. During the comment period, 
comments may be viewed online through the FDMS.

[[Page 19313]]


FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 
or FAX (202) 632-8925.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995, 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.
    Authority: Public Law 104-13; 44 U.S.C. 3501-21.
    Title: Operation Enduring Freedom/Operation Iraqi Freedom Seriously 
Injured/Ill Service Member Veteran Worksheet (VA Form 21-0773).
    OMB Control Number: 2900-0720.
    Type of Review: Revision of an approved collection.
    Abstract: VA Form 21-0773 is a checklist for Veterans Service 
Representatives to verify they have given information, applications, 
and/or referral service to our Operation Enduring Freedom or Operation 
Iraqi Freedom service members who have at least six months remaining on 
active duty and who may have suffered a serious injury or illness. This 
form will be maintained in the veteran's claims folder.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 7,000 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 14,000.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of 
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-08438 Filed 4-25-17; 8:45 am]
 BILLING CODE 8320-01-P

19312 Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices

period, comments may be viewed online examinations. VA gathers medical By direction of the Secretary.
through the FDMS. information related to the claimant that Cynthia Harvey-Pryor,
FOR FURTHER INFORMATION CONTACT: is necessary to adjudicate the claim for Department Clearance Officer, Enterprise
Nancy J. Kessinger at (202) 632–8924 or VA disability benefits. The Disability Records Service, Office of Quality and
FAX (202) 632–8925. Benefit Questionnaire title will include Compliance, Department of Veterans Affairs.
SUPPLEMENTARY INFORMATION: Under the the name of the specific disability for [FR Doc. 2017–08440 Filed 4–25–17; 8:45 am]
PRA of 1995, Federal agencies must which it will gather information. VAF BILLING CODE 8320–01–P
obtain approval from the Office of 21–0960A–2, Artery and Vein
Management and Budget (OMB) for each Conditions vascular diseases including
collection of information they conduct varicose veins) Disability Benefits DEPARTMENT OF VETERANS
or sponsor. This request for comment is Questionnaire, will gather information AFFAIRS
being made pursuant to Section related to the claimant’s diagnosis of
3506(c)(2)(A) of the PRA. arteries, veins, and/or peripheral [OMB Control No. 2900–0720]
With respect to the following vascular disease; VAF 21–0960A–3,
collection of information, VBA invites Hypertension, Disability Benefits Agency Information Collection
comments on: (1) Whether the proposed Questionnaire, will gather information Activity: Operation Enduring Freedom/
collection of information is necessary related to the claimant’s diagnosis of Operation Iraqi Freedom Seriously
for the proper performance of VBA’s hypertension; VAF 21–0960A–4, Non- Injured/Ill Service Member Veteran
functions, including whether the ischemic Heart Disease (including Worksheet
information will have practical utility; Arrhythmias and Surgery) Disability
(2) the accuracy of VBA’s estimate of the Benefits Questionnaire, will gather AGENCY: Veterans Benefits
burden of the proposed collection of information related to the claimant’s Administration, Department of Veterans
information; (3) ways to enhance the diagnosis of any non-ischemic heart Affairs.
quality, utility, and clarity of the disease; VAF 21–0960C–4, Diabetic ACTION: Notice.
information to be collected; and (4) Peripheral Neuropathy (diabetic
ways to minimize the burden of the sensory-motor peripheral neuropathy) SUMMARY: The Veterans Benefits
collection of information on Disability Benefits Questionnaire will Administration (VBA), Department of
respondents, including through the use gather information related to the Veterans Affairs (VA), is announcing an
of automated collection techniques or claimant’s diagnosis of a diabetic opportunity for public comment on the
the use of other forms of information sensory-motor peripheral neuropathy
proposed collection of certain
technology. condition; VAF 21–0960E–1, Diabetes
information by the agency. Under the
Mellitus Disability Benefits
Authority: Public Law 104–13; 44 U.S.C. Paperwork Reduction Act (PRA) of
Questionnaire, will gather information
3501–21. 1995, Federal agencies are required to
related to the claimant’s diagnosis of
Title: (Artery and Vein Conditions publish notice in the Federal Register
diabetes mellitus; VAF 21–0960F–1,
(Vascular Diseases Including Varicose concerning each proposed collection of
Scars/Disfigurement Disability Benefits
Veins) Disability Benefits Questionnaire information, including each proposed
Questionnaire will gather information
(VA Form 21–0960A–2), Hypertension revision of a currently approved
related to the claimant’s diagnosis of
Disability Benefits Questionnaire (VA collection, and allow 60 days for public
any scars or disfigurement; VAF 21–
Form 21–0960A–3), Non-Ischemic Heart 0960F–2, Skin Diseases Disability comment in response to the notice. VA
Disease (Including Arrhythmias and Benefits Questionnaire, will gather Form 21–0773 is a checklist for Veterans
Surgery) Disability Benefits information related to the claimant’s Service Representatives to verify they
Questionnaire (VA Form 21–0960A–4), diagnosis of any skin disease. VAF 21– have given information, applications,
Diabetic Peripheral Neuropathy 0960M–1 Amputations Disability and/or referral service to our Operation
(Diabetic Sensory-Motor Peripheral Benefits Questionnaire, will gather Enduring Freedom or Operation Iraqi
Neuropathy) Disability Benefits information related to the claimant’s Freedom service members who have at
Questionnaire (VA Form 21–0960C–4), amputations; VAF 21–0960M–10 least six months remaining on active
Diabetes Mellitus Disability Benefits Muscle Injuries Disability Benefits duty and who may have suffered a
Questionnaire (VA Form 21–0960E–1), Questionnaire, will gather information serious injury or illness. This form will
Scars/Disfigurement Disability Benefits related to the claimant’s diagnosis of a be maintained in the veteran’s claims
Questionnaire (VA Form 21–0960F–1), muscle injury disability. VAF 21– folder.
Skin Diseases Disability Benefits 0960M–15 Temporomandibular Joint DATES: Written comments and
Questionnaire (VA Form 21–0960F–2), (TMJ) Conditions Disability Benefits recommendations on the proposed
Amputations Disability Benefits Questionnaire, will gather information collection of information should be
Questionnaire (VA Form 21–0960M–1), related to the claimant’s diagnosis of received on or before June 26, 2017.
Muscles Injuries Disability Benefits temporomandibular joint dysfunction or
Questionnaire (VA Form 21–0960M– TMJ. VAF 21–0960N–2 Eye Conditions ADDRESSES: Submit written comments
10), Temporomandibular Joint (TMJ) Disability Benefits Questionnaire will on the collection of information through
Conditions Disability Benefits gather information related to the Federal Docket Management System
Questionnaire (VA Form 21–0960M– claimant’s diagnosis of an eye (FDMS) at www.Regulations.gov or to
15), Eye Conditions Disability Benefits condition. Nancy J. Kessinger, Veterans Benefits
Administration (20M33), Department of
mstockstill on DSK30JT082PROD with NOTICES

Questionnaire (VA Form 21–0960N–2)). Affected Public: Individuals or
OMB Control Number: 2900–0776. households. Veterans Affairs, 810 Vermont Avenue
Type of Review: Extension of an Estimated Annual Burden: 162,500. NW., Washington, DC 20420 or email to
approved collection. Estimated Average Burden per nancy.kessinger@va.gov. Please refer to
Abstract: VA Form 21–0960 series is Respondent: 25 minutes. ‘‘OMB Control No. 2900–0720 ’’ in any
used to gather necessary information Frequency of Response: One time. correspondence. During the comment
from a claimant’s treating physician Estimated Number of Respondents: period, comments may be viewed online
regarding the results of medical 400,000. through the FDMS.

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Federal Register / Vol. 82, No. 79 / Wednesday, April 26, 2017 / Notices 19313

FOR FURTHER INFORMATION CONTACT: DEPARTMENT OF VETERANS c. VA Form 10–10HS collects
Nancy J. Kessinger at (202) 632–8924 or AFFAIRS information only from veterans who are
FAX (202) 632–8925. in a copay required status for hospital
[OMB Control No. 2900–0091]
SUPPLEMENTARY INFORMATION: Under the care and medical services, but due to a
PRA of 1995, Federal agencies must Agency Information Collection Activity loss of income project their income for
obtain approval from the Office of Under OMB Review: Application and the current year will be substantially
Management and Budget (OMB) for each Renewal for Health Care Benefits below the VA means test limits.
collection of information they conduct An agency may not conduct or
AGENCY: Veterans Health
or sponsor. This request for comment is sponsor, and a person is not required to
Administration, Department of Veterans
being made pursuant to Section respond to a collection of information
Affairs.
3506(c)(2)(A) of the PRA. unless it displays a currently valid OMB
ACTION: Notice.
With respect to the following control number. The Federal Register
collection of information, VBA invites SUMMARY: In compliance with the Notice with a 60-day comment period
comments on: (1) Whether the proposed Paperwork Reduction Act (PRA) of soliciting comments on this collection
collection of information is necessary 1995, this notice announces that the of information was published on
for the proper performance of VBA’s Veterans Health Administration (VHA), February 1, January 19, 2017, Volume
functions, including whether the Department of Veterans Affairs, will 82, No. 20, page 8971.
information will have practical utility; submit the collection of information
(2) the accuracy of VBA’s estimate of the abstracted below to the Office of Affected Public: Individuals or
burden of the proposed collection of Management and Budget (OMB) for households.
information; (3) ways to enhance the review and comment. The PRA Estimated Annual Burden:
quality, utility, and clarity of the submission describes the nature of the a. Enrollment Application for VA
information to be collected; and (4) information collection and its expected Health Care—VA Form 10–10EZ—
ways to minimize the burden of the cost and burden; it includes the actual 270,000 hours.
collection of information on data collection instrument.
respondents, including through the use DATES: Comments must be submitted on b. Application for Renewal of Health
of automated collection techniques or or before May 26, 2017. Care Benefits—VA Form 10–10EZR—
the use of other forms of information ADDRESSES: Submit written comments
343,600 hours.
technology. on the collection of information through c. Request for Hardship
Authority: Public Law 104–13; 44 www.Regulations.gov, or to Office of Determination—VA Form 10–10HS—
U.S.C. 3501–21. Information and Regulatory Affairs, 1,750 hours.
Title: Operation Enduring Freedom/ Office of Management and Budget, Attn: Estimated Average Burden per
Operation Iraqi Freedom Seriously VA Desk Officer; 725 17th St. NW., Respondent:
Injured/Ill Service Member Veteran Washington, DC 20503 or sent through
Worksheet (VA Form 21–0773). electronic mail to oira_submission@ a. Enrollment Application for VA
OMB Control Number: 2900–0720. omb.eop.gov. Please refer to ‘‘OMB Health Care—VA Form 10–10EZ—30
Type of Review: Revision of an Control No. 2900–0091’’ in any minutes.
approved collection. correspondence. b. Application for Renewal of Health
Abstract: VA Form 21–0773 is a FOR FURTHER INFORMATION CONTACT: Care Benefits—VA Form 10–10EZR—24
checklist for Veterans Service Cynthia Harvey-Pryor, Enterprise minutes.
Representatives to verify they have Records Service (005R1B), Department c. Request for Hardship
given information, applications, and/or of Veterans Affairs, 810 Vermont Determination—VA Form 10–10HS—15
referral service to our Operation Avenue NW., Washington, DC 20420, minutes.
Enduring Freedom or Operation Iraqi (202) 461–5870 or email cynthia.harvey-
Freedom service members who have at pryor@va.gov. Please refer to ‘‘OMB Frequency of Response: Annually.
least six months remaining on active Control No. 2900–0091.’’ Estimated Annual Responses:
duty and who may have suffered a SUPPLEMENTARY INFORMATION: a. Enrollment Application for VA
serious injury or illness. This form will Authority: 44 U.S.C. 3501–3521. Health Care—VA Form 10–10EZ—
be maintained in the veteran’s claims 540,000.
folder. Titles:
1. Enrollment Application for VA b. Application for Renewal of Health
Affected Public: Individuals or
Health Care—VA Form 10–10EZ. Care Benefits—VA Form 10–10EZR—
households.
2. Application for Renewal of Health 859,000.
Estimated Annual Burden: 7,000 Care Benefits—VA Form 10–10EZR.
hours. c. Request for Hardship
3. Request for Hardship
Estimated Average Burden per Determination—VA Form 10–10HS. Determination—VA Form 10–10HS—
Respondent: 30 minutes. OMB Control Number: 2900–0091. 7,000.
Frequency of Response: One time. Type of Review: Reinstatement. By direction of the Secretary.
Estimated Number of Respondents: Abstracts: Cynthia Harvey-Pryor,
14,000. a. VA Form 10–10EZ collects
information only from new applicants Department Clearance Officer, Enterprise
mstockstill on DSK30JT082PROD with NOTICES

By direction of the Secretary. for VA medical care, nursing home, Records Service, Office of Quality and
Cynthia Harvey-Pryor, Compliance, Department of Veterans Affairs.
domiciliary, dental benefits, and new
Department Clearance Officer, Enterprise [FR Doc. 2017–08441 Filed 4–25–17; 8:45 am]
enrollees in the VA health care system.
Records Service, Office of Quality and b. VA Form 10–10EZR, Health BILLING CODE 8320–01–P
Compliance, Department of Veterans Affairs. Benefits Renewal Form, is used to
[FR Doc. 2017–08438 Filed 4–25–17; 8:45 am] collect data from those veterans who
BILLING CODE 8320–01–P wish to update their application data.

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Document Created: 2017-04-26 03:15:53
Document Modified: 2017-04-26 03:15:53

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 June 26, 2017.
Contact		Nancy J. Kessinger at (202) 632-8924 or FAX (202) 632-8925.
FR Citation		82 FR 19312