82_FR_56559 82 FR 56332 - Agency Information Collection Activity Under OMB Review: Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases Disability Benefits Questionnaire, Amputations Disability Benefits Questionnaire, Muscles Injuries Disability Benefits Questionnaire, Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire, Eye Conditions Disability Benefits Questionnaire

82 FR 56332 - Agency Information Collection Activity Under OMB Review: Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases Disability Benefits Questionnaire, Amputations Disability Benefits Questionnaire, Muscles Injuries Disability Benefits Questionnaire, Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire, Eye Conditions Disability Benefits Questionnaire

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 227 (November 28, 2017)

Page Range56332-56333
FR Document2017-25592

In compliance with the Paperwork Reduction Act (PRA) of 1995, this notice announces that the Veterans Benefits Administration, 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 it includes the actual data collection instrument.

Federal Register, Volume 82 Issue 227 (Tuesday, November 28, 2017) 
[Federal Register Volume 82, Number 227 (Tuesday, November 28, 2017)]
[Notices]
[Pages 56332-56333]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-25592]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0776]


Agency Information Collection Activity Under OMB Review: Artery 
and Vein Conditions (Vascular Diseases Including Varicose Veins) 
Disability Benefits Questionnaire, Hypertension Disability Benefits 
Questionnaire, Non-Ischemic Heart Disease (Including Arrhythmias and 
Surgery) Disability Benefits Questionnaire, Diabetic Peripheral 
Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) Disability 
Benefits Questionnaire, Diabetes Mellitus Disability Benefits 
Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire, 
Skin Diseases Disability Benefits Questionnaire, Amputations Disability 
Benefits Questionnaire, Muscles Injuries Disability Benefits 
Questionnaire, Temporomandibular Joint (TMJ) Conditions Disability 
Benefits Questionnaire, Eye Conditions Disability Benefits 
Questionnaire

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
this notice announces that the Veterans Benefits Administration, 
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 it 
includes the actual data collection instrument.

DATES: Comments must be submitted on or before December 28, 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-
0776'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department of Veterans Affairs, 811 Vermont 
Avenue NW., Washington, DC 20420, (202) 461-5870 or email 
[email protected]. Please refer to ``OMB Control No. 2900-
0776'' in any correspondence.

SUPPLEMENTARY INFORMATION:

    Authority:  44 U.S.C. 3501-21.
    Title: Artery and Vein Conditions (Vascular Diseases Including 
Varicose Veins) Disability Benefits Questionnaire (VA Form 21-0960A-2), 
Hypertension Disability Benefits Questionnaire (VA Form 21-0960A-3), 
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) 
Disability Benefits Questionnaire (VA Form 21-0960A-4), Diabetic 
Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) 
Disability Benefits Questionnaire (VA Form 21-0960C-4), Diabetes 
Mellitus Disability Benefits Questionnaire (VA Form 21-0960E-1), Scars/
Disfigurement Disability Benefits Questionnaire (VA Form 21-0960F-1), 
Skin Diseases Disability Benefits Questionnaire (VA Form 21-0960F-2), 
Amputations Disability Benefits Questionnaire (VA Form 21-0960M-1), 
Muscles Injuries Disability Benefits Questionnaire (VA Form 21-0960M-
10), Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire (VA Form 21-0960M-15), Eye Conditions Disability Benefits 
Questionnaire (VA Form 21-0960N-2)
    OMB Control Number: 2900-0776.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 21-0960 series is used to gather necessary 
information from a claimant's treating physician regarding the results 
of medical examinations. VA gathers medical information related to the 
claimant that is necessary to adjudicate the claim for VA disability 
benefits. The Disability Benefit Questionnaire title will include the 
name of the specific disability for which it will gather information. 
VAF 21-0960A-2, Artery and Vein Conditions vascular diseases including 
varicose veins) Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of arteries, veins, 
and/or peripheral vascular disease; VAF 21-0960A-3, Hypertension, 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of hypertension; VAF 21-0960A-4, Non-ischemic 
Heart Disease (including Arrhythmias and Surgery) Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of any non-ischemic heart disease; VAF 21-0960C-4, Diabetic 
Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy) 
Disability Benefits Questionnaire will gather information related to 
the claimant's diagnosis of a diabetic sensory-motor peripheral 
neuropathy condition; VAF 21-0960E-1, Diabetes Mellitus Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of diabetes mellitus; VAF 21-0960F-1, Scars/
Disfigurement Disability Benefits Questionnaire will gather information 
related to the claimant's diagnosis of any scars or disfigurement; VAF 
21-0960F-2, Skin Diseases Disability Benefits Questionnaire, will 
gather information related to the claimant's diagnosis of any skin 
disease. VAF 21-0960M-1, Amputations Disability Benefits Questionnaire, 
will gather information related to the claimant's amputations; VAF 21-
0960M-10, Muscle Injuries Disability Benefits Questionnaire, will 
gather information related to the claimant's diagnosis of a muscle 
injury disability. VAF 21-

[[Page 56333]]

0960M-15, Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of temporomandibular joint dysfunction or TMJ. VAF 21-0960N-
2, Eye Conditions Disability Benefits Questionnaire will gather 
information related to the claimant's diagnosis of an eye condition.
    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 at 82 FR 79 on April 26, 2017, pages 19311 
and 19312.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 162,500.
    Estimated Average Burden per Respondent: 25 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 400,000.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of Quality, Privacy and Risk, 
Department of Veterans Affairs.
[FR Doc. 2017-25592 Filed 11-27-17; 8:45 am]
 BILLING CODE 8320-01-P

56332 Federal Register / Vol. 82, No. 227 / Tuesday, November 28, 2017 / Notices Committee name Committee description Charter renewed on Veterans’ Advisory Com- Provides advice to the Secretary on the rehabilitation needs of disabled Veterans and September 25, 2017. mittee on Rehabilitation. the administration of VA’s rehabilitation programs. Advisory Committee on Provides advice to the Secretary on the needs of women Veterans regarding health September 29, 2017. Women Veterans. care, rehabilitation benefits, compensation, outreach, and other programs adminis- tered by VA. FOR FURTHER INFORMATION CONTACT: abstracted below to the Office of 15), Eye Conditions Disability Benefits Jeffrey Moragne, Committee Management and Budget (OMB) for Questionnaire (VA Form 21–0960N–2) Management Office, Department of review and comment. The PRA OMB Control Number: 2900–0776. Veterans Affairs, Advisory Committee submission describes the nature of the Type of Review: Extension of a Management Office (00AC), 810 information collection and its expected currently approved collection. Vermont Avenue NW., Washington, DC cost and burden and it includes the Abstract: VA Form 21–0960 series is 20420; telephone (202) 266–4660; or actual data collection instrument. used to gather necessary information email at Jeffrey.Moragne@va.gov. To from a claimant’s treating physician DATES: Comments must be submitted on regarding the results of medical view a copy of a VA Federal advisory or before December 28, 2017. committee charter, visit http:// examinations. VA gathers medical www.va.gov/advisory. ADDRESSES: Submit written comments information related to the claimant that on the collection of information through is necessary to adjudicate the claim for Dated: November 22, 2017. VA disability benefits. The Disability www.Regulations.gov, or to Office of Jelessa M. Burney, Information and Regulatory Affairs, Benefit Questionnaire title will include Federal Advisory Committee Management Office of Management and Budget, Attn: the name of the specific disability for Officer. VA Desk Officer; 725 17th St. NW., which it will gather information. VAF [FR Doc. 2017–25630 Filed 11–27–17; 8:45 am] Washington, DC 20503 or sent through 21–0960A–2, Artery and Vein BILLING CODE 8320–01–P electronic mail to oira_submission@ Conditions vascular diseases including omb.eop.gov. Please refer to ‘‘OMB varicose veins) Disability Benefits Control No. 2900–0776’’ in any Questionnaire, will gather information DEPARTMENT OF VETERANS correspondence. related to the claimant’s diagnosis of AFFAIRS arteries, veins, and/or peripheral FOR FURTHER INFORMATION CONTACT: vascular disease; VAF 21–0960A–3, [OMB Control No. 2900–0776] Cynthia Harvey-Pryor, Enterprise Hypertension, Disability Benefits Records Service (005R1B), Department Questionnaire, will gather information Agency Information Collection Activity of Veterans Affairs, 811 Vermont related to the claimant’s diagnosis of Under OMB Review: Artery and Vein Avenue NW., Washington, DC 20420, hypertension; VAF 21–0960A–4, Non- Conditions (Vascular Diseases (202) 461–5870 or email cynthia.harvey- ischemic Heart Disease (including Including Varicose Veins) Disability pryor@va.gov. Please refer to ‘‘OMB Arrhythmias and Surgery) Disability Benefits Questionnaire, Hypertension Control No. 2900–0776’’ in any Benefits Questionnaire, will gather Disability Benefits Questionnaire, Non- correspondence. information related to the claimant’s Ischemic Heart Disease (Including Arrhythmias and Surgery) Disability SUPPLEMENTARY INFORMATION: diagnosis of any non-ischemic heart Benefits Questionnaire, Diabetic disease; VAF 21–0960C–4, Diabetic Authority: 44 U.S.C. 3501–21. Peripheral Neuropathy (diabetic Peripheral Neuropathy (Diabetic Title: Artery and Vein Conditions sensory-motor peripheral neuropathy) Sensory-Motor Peripheral Neuropathy) (Vascular Diseases Including Varicose Disability Benefits Questionnaire will Disability Benefits Questionnaire, Veins) Disability Benefits Questionnaire gather information related to the Diabetes Mellitus Disability Benefits (VA Form 21–0960A–2), Hypertension claimant’s diagnosis of a diabetic Questionnaire, Scars/Disfigurement Disability Benefits Questionnaire (VA sensory-motor peripheral neuropathy Disability Benefits Questionnaire, Skin Form 21–0960A–3), Non-Ischemic Heart condition; VAF 21–0960E–1, Diabetes Diseases Disability Benefits Disease (Including Arrhythmias and Mellitus Disability Benefits Questionnaire, Amputations Disability Surgery) Disability Benefits Questionnaire, will gather information Benefits Questionnaire, Muscles Questionnaire (VA Form 21–0960A–4), related to the claimant’s diagnosis of Injuries Disability Benefits Diabetic Peripheral Neuropathy diabetes mellitus; VAF 21–0960F–1, Questionnaire, Temporomandibular (Diabetic Sensory-Motor Peripheral Scars/Disfigurement Disability Benefits Joint (TMJ) Conditions Disability Neuropathy) Disability Benefits Questionnaire will gather information Benefits Questionnaire, Eye Questionnaire (VA Form 21–0960C–4), related to the claimant’s diagnosis of Conditions Disability Benefits Diabetes Mellitus Disability Benefits any scars or disfigurement; VAF 21– Questionnaire Questionnaire (VA Form 21–0960E–1), 0960F–2, Skin Diseases Disability AGENCY: Veterans Benefits Scars/Disfigurement Disability Benefits Benefits Questionnaire, will gather Administration, Department of Veterans Questionnaire (VA Form 21–0960F–1), information related to the claimant’s Affairs. Skin Diseases Disability Benefits diagnosis of any skin disease. VAF 21– ACTION: Notice. Questionnaire (VA Form 21–0960F–2), 0960M–1, Amputations Disability ethrower on DSK3G9T082PROD with NOTICES Amputations Disability Benefits Benefits Questionnaire, will gather SUMMARY: In compliance with the Questionnaire (VA Form 21–0960M–1), information related to the claimant’s Paperwork Reduction Act (PRA) of Muscles Injuries Disability Benefits amputations; VAF 21–0960M–10, 1995, this notice announces that the Questionnaire (VA Form 21–0960M– Muscle Injuries Disability Benefits Veterans Benefits Administration, 10), Temporomandibular Joint (TMJ) Questionnaire, will gather information Department of Veterans Affairs, will Conditions Disability Benefits related to the claimant’s diagnosis of a submit the collection of information Questionnaire (VA Form 21–0960M– muscle injury disability. VAF 21– VerDate Sep<11>2014 19:51 Nov 27, 2017 Jkt 244001 PO 00000 Frm 00125 Fmt 4703 Sfmt 4703 E:\FR\FM\28NON1.SGM 28NON1

Federal Register / Vol. 82, No. 227 / Tuesday, November 28, 2017 / Notices 56333 0960M–15, Temporomandibular Joint DEPARTMENT OF VETERANS 5870 or email cynthia.harvey-pryor@ (TMJ) Conditions Disability Benefits AFFAIRS va.gov. Please refer to ‘‘OMB Control Questionnaire, will gather information No. 2900–0711’’ in any correspondence. [OMB Control No. 2900–0711] related to the claimant’s diagnosis of SUPPLEMENTARY INFORMATION: temporomandibular joint dysfunction or Agency Information Collection Activity Authority: Public Law 104–13; 44 U.S.C. TMJ. VAF 21–0960N–2, Eye Conditions Under OMB Review: VBA Loan 3501–3521. Disability Benefits Questionnaire will Guaranty Service Lender Satisfaction Title: VBA Loan Guaranty Service gather information related to the Survey Lender Satisfaction Survey. claimant’s diagnosis of an eye OMB Control Number: 2900–0711. AGENCY: Loan Guaranty Service, condition. Department of Veterans Affairs. Type of Review: Extension of a An agency may not conduct or ACTION: Notice. currently approved collection. sponsor, and a person is not required to Abstract: As part of the agency’s respond to a collection of information SUMMARY: In compliance with the continuing commitment to improve the unless it displays a currently valid OMB Paperwork Reduction Act (PRA) of services provided to veterans, VA will control number. The Federal Register 1995, this notice announces that the conduct the VBA Loan Guaranty Service Notice with a 60-day comment period Loan Guaranty Service, Department of Lender Satisfaction Survey. The soliciting comments on this collection Veterans Affairs, will submit the proposed effort will measure lender collection of information abstracted satisfaction with the various aspects of of information was published at 82 FR below to the Office of Management and the VA Home Loan Guaranty program. 79 on April 26, 2017, pages 19311 and Budget (OMB) for review and comment. An agency may not conduct or 19312. The PRA submission describes the sponsor, and a person is not required to Affected Public: Individuals or nature of the information collection and respond to a collection of information Households. its expected cost and burden and it unless it displays a currently valid OMB Estimated Annual Burden: 162,500. includes the actual data collection control number. The Federal Register instrument. Notice with a 60-day comment period Estimated Average Burden per DATES: Comments must be submitted on soliciting comments on this collection Respondent: 25 minutes. of information was published at 82 FR or before December 28, 2017. Frequency of Response: One time. ADDRESSES: Submit written comments 38760 on August 15, 2017, pages 38760– Estimated Number of Respondents: on the collection of information through 38761. 400,000. www.Regulations.gov, or to Office of Affected Public: Private sector. Information and Regulatory Affairs, Estimated Annual Burden: 69 hours. By direction of the Secretary. Office of Management and Budget, Attn: Estimated Average Burden per Cynthia Harvey-Pryor, Respondent: 15 minutes. VA Desk Officer; 725 17th St. NW., Department Clearance Officer, Office of Washington, DC 20503 or sent through Frequency of Response: One time. Quality, Privacy and Risk, Department of electronic mail to oira_submission@ Estimated Number of Respondents: Veterans Affairs. omb.eop.gov. Please refer to ‘‘OMB 275. [FR Doc. 2017–25592 Filed 11–27–17; 8:45 am] Control No. 2900–0711’’ in any By direction of the Secretary. BILLING CODE 8320–01–P correspondence. Cynthia Harvey-Pryor, FOR FURTHER INFORMATION CONTACT: Department Clearance Officer, Office of Cynthia Harvey-Pryor, Office of Quality, Quality, Privacy and Risk, Department of Privacy and Risk (OQPR), Department of Veterans Affairs. Veterans Affairs, 810 Vermont Avenue [FR Doc. 2017–25591 Filed 11–27–17; 8:45 am] NW., Washington, DC 20420, (202) 461– BILLING CODE 8320–01–P ethrower on DSK3G9T082PROD with NOTICES VerDate Sep<11>2014 19:51 Nov 27, 2017 Jkt 244001 PO 00000 Frm 00126 Fmt 4703 Sfmt 9990 E:\FR\FM\28NON1.SGM 28NON1


Document Created: 2017-11-28 01:51:01
Document Modified: 2017-11-28 01:51:01
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesComments must be submitted on or before December 28, 2017.
ContactCynthia Harvey-Pryor, Enterprise Records Service (005R1B), Department of Veterans Affairs, 811 Vermont Avenue NW., Washington, DC 20420, (202) 461-5870 or email [email protected] Please refer to ``OMB Control No. 2900- 0776'' in any correspondence.
FR Citation82 FR 56332 
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