82 FR 19313 - Agency Information Collection Activity Under OMB Review: Application and Renewal for Health Care Benefits

DEPARTMENT OF VETERANS AFFAIRS

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

Page Range		19313-19313
FR Document		2017-08441

In compliance with the Paperwork Reduction Act (PRA) of 1995, 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; it includes the actual data collection instrument.

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

[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Page 19313]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-08441]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0091]


Agency Information Collection Activity Under OMB Review: 
Application and Renewal for Health Care Benefits

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
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; it 
includes the actual data collection instrument.

DATES: Comments must be submitted on or before May 26, 2017.

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-
0091'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department of Veterans Affairs, 810 Vermont 
Avenue NW., Washington, DC 20420, (202) 461-5870 or email 
[email protected]. Please refer to ``OMB Control No. 2900-
0091.''

SUPPLEMENTARY INFORMATION: 

    Authority:  44 U.S.C. 3501-3521.

    Titles:
    1. Enrollment Application for VA Health Care--VA Form 10-10EZ.
    2. Application for Renewal of Health Care Benefits--VA Form 10-
10EZR.
    3. Request for Hardship Determination--VA Form 10-10HS.
    OMB Control Number: 2900-0091.
    Type of Review: Reinstatement.
    Abstracts:
    a. VA Form 10-10EZ collects information only from new applicants 
for VA medical care, nursing home, domiciliary, dental benefits, and 
new enrollees in the VA health care system.
    b. VA Form 10-10EZR, Health Benefits Renewal Form, is used to 
collect data from those veterans who wish to update their application 
data.
    c. VA Form 10-10HS collects information only from veterans who are 
in a copay required status for hospital care and medical services, but 
due to a loss of income project their income for the current year will 
be substantially below the VA means test limits.
    An agency may not conduct or sponsor, and a person is not required 
to respond to a collection of information unless it displays a 
currently valid OMB control number. The Federal Register Notice with a 
60-day comment period soliciting comments on this collection of 
information was published on February 1, January 19, 2017, Volume 82, 
No. 20, page 8971.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Enrollment Application for VA Health Care--VA Form 10-10EZ--
270,000 hours.
    b. Application for Renewal of Health Care Benefits--VA Form 10-
10EZR--343,600 hours.
    c. Request for Hardship Determination--VA Form 10-10HS--1,750 
hours.
    Estimated Average Burden per Respondent:
    a. Enrollment Application for VA Health Care--VA Form 10-10EZ--30 
minutes.
    b. Application for Renewal of Health Care Benefits--VA Form 10-
10EZR--24 minutes.
    c. Request for Hardship Determination--VA Form 10-10HS--15 minutes.
    Frequency of Response: Annually.
    Estimated Annual Responses:
    a. Enrollment Application for VA Health Care--VA Form 10-10EZ--
540,000.
    b. Application for Renewal of Health Care Benefits--VA Form 10-
10EZR--859,000.
    c. Request for Hardship Determination--VA Form 10-10HS--7,000.

    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. 2017-08441 Filed 4-25-17; 8:45 am]
 BILLING CODE 8320-01-P

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.

VerDate Sep<11>2014 18:43 Apr 25, 2017 Jkt 241001 PO 00000 Frm 00117 Fmt 4703 Sfmt 9990 E:\FR\FM\26APN1.SGM 26APN1

Document Created: 2017-04-26 03:15:49
Document Modified: 2017-04-26 03:15:49

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		Comments must be submitted on or before May 26, 2017.
Contact		Cynthia Harvey-Pryor, Enterprise Records Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461-5870 or email [email protected] Please refer to ``OMB Control No. 2900- 0091.''
FR Citation		82 FR 19313