82 FR 8566 - Proposed Information Collection Activity: (Income Verification)

DEPARTMENT OF VETERANS AFFAIRS

Federal Register Volume 82, Issue 16 (January 26, 2017)

Page Range		8566-8567
FR Document		2017-01753

The Veterans Health Administration (VHA) 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 this new collection, and allow 60 days for public comment in response to the notice. This notice solicits comments on information needed to identify areas for improvement in clinical training programs.

Federal Register, Volume 82 Issue 16 (Thursday, January 26, 2017)

[Federal Register Volume 82, Number 16 (Thursday, January 26, 2017)]
[Notices]
[Pages 8566-8567]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-01753]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]


Proposed Information Collection Activity: (Income Verification)

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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

SUMMARY: The Veterans Health Administration (VHA) 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 
this new collection, and allow 60 days for public comment in response 
to the notice. This notice solicits comments on information needed to 
identify areas for improvement in clinical training programs.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before March 27, 2017.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to 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-NEW'' in any correspondence. During the comment period, 
comments may be viewed online through 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 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 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:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1
    c. Mailed to Veterans When Necessary--HEC Form 340-1
    d. Mailed to Veterans When Necessary--Checklist.
    OMB Control Number: 2900-NEW.
    Type of Review: New collection.
    Abstract: The HEC, IVD uses HEC Form 200-1A (Veteran's Income 
Verification Response) to collect income verification information, as 
applicable, from the Veteran by requesting the

[[Page 8567]]

Veteran to verify the listed income on the form as reported to IVD by 
IRS/SSA, to select the appropriate option on the form relating to the 
household income, attest to out of pocket medical expenses, attest to 
sale of primary home real estate and attest to separation from spouse 
for the income year under the Income Verification Division's review. 
The Veteran's signature is required on page 2 of HEC Form 200-1A. If 
the Veteran has medical/health limitations that does not enable the 
Veteran to physically sign the form with a wet signature, the Veteran 
must mark an ``X'' to designate a signature; two witnesses must verify 
the ``X'' as the Veteran's signature. HEC, IVD will use the completed 
HEC Form 200-1A to assist in verifying the Veteran's correct gross 
household income to ensure the Veteran is placed in the correct 
priority group for health care.
    The HEC, IVD uses HEC Form 220-1 (Spouse's Income Verification 
Response) to collect income verification information, as applicable, 
from the Veteran's spouse by requesting the spouse to verify the listed 
income on the form as reported to IVD by IRS/SSA, report any additional 
income not reported by IRS/SSA and sign and date the form. If the 
spouse has medical/health limitations that does not enable the spouse 
to physically sign the form with a wet signature, the spouse must mark 
an ``X'' to designate a signature; two witnesses must verify the ``X'' 
as the Veteran's signature. HEC, IVD will use the completed HEC Form 
220-1 to assist in verifying the Veteran's correct gross household 
income to ensure the Veteran is placed in the correct priority group 
for health care.
    The HEC, IVD uses the HEC Form 340-1 (Declaration of 
Representative) for the Veteran and the spouse (if applicable) to 
appoint a representative, authorizing HEC, IVD to release information 
to a designated appointee for a specific income year. Such information 
includes confidential federal tax information, other income, and 
medical benefits eligibility related information. The Veteran and 
spouse (if applicable) must sign and date the form.
    The HEC, IVD uses the HEC Income Verification--Additional 
Information Checklist to request from the Veteran any additional 
information needed to adjudicate the Income Verification case. The 
Veteran providing the requested information usually results in the best 
interest to the Veteran.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--89,001 
hours
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--28,530 
hours
    c. Mailed to Veterans When Necessary--HEC Form 340-1--1,701 hours
    d. Mailed to Veterans When Necessary--Checklist--761 hours
    Estimated Average Burden per Respondent:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--30 
minutes
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--20 minutes
    c. Mailed to Veterans When Necessary--HEC Form 340-1--15 minutes
    d. Mailed to Veterans When Necessary--Checklist--761--15 minutes
    Frequency of Response: Annually.
    Estimated Annual Responses:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--178,002
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--85,590
    c. Mailed to Veterans When Necessary--HEC Form 340-1--6,805
    d. Mailed to Veterans When Necessary--Checklist--761--3,044

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Program Specialist, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-01753 Filed 1-25-17; 8:45 am]
 BILLING CODE 8320-01-P

8566 Federal Register / Vol. 82, No. 16 / Thursday, January 26, 2017 / Notices

By direction of the Secretary. Type of Review: Extension of an collection, and allow 60 days for public
Cynthia Harvey-Pryor, approved collection. comment in response to the notice. This
Agency Clearance Officer, Office of Privacy Abstract: Section 3119 of title 38, notice solicits comments on information
and Records Management, Department of United States Code, authorizes the needed to identify areas for
Veterans Affairs. Secretary of Veterans Affairs to make improvement in clinical training
[FR Doc. 2017–01750 Filed 1–25–17; 8:45 am] grants to or contract with public or programs.
BILLING CODE 8320–01–P nonprofit agencies, including DATES: Written comments and
institutions of higher learning, to recommendations on the proposed
advance ‘‘the knowledge, methods, collection of information should be
DEPARTMENT OF VETERANS techniques, and resources available for received on or before March 27, 2017.
AFFAIRS use in rehabilitation programs for
ADDRESSES: Submit written comments
veterans.’’ Section 3119 specifically
[OMB Control No. 2900–0847]
on the collection of information through
authorizes the Secretary to make grants
the Federal Docket Management System
to such agencies to conduct or provide
Agency Information Collection Activity (FDMS) at www.Regulations.gov; or to
support for projects which are
Under OMB Review: Submission of Brian McCarthy, Office of Regulatory
‘‘designed to increase the resources and
School Catalog to the State Approving and Administrative Affairs, Veterans
potential for accomplishing the
Agency Health Administration (10B4),
rehabilitation of disabled veterans.’’ VA
Department of Veterans Affairs, 810
AGENCY: Veterans Benefits has codified these provisions in its
Vermont Avenue NW., Washington, DC
Administration, Department of Veterans regulations at 38 CFR 21.390
20420 or email: Brian.McCarthy4@
Affairs. Rehabilitation research and special
va.gov. Please refer to ‘‘OMB Control
projects. The purpose of the VEPFS
ACTION: Notice. No. 2900–NEW’’ in any correspondence.
program is to provide one or more
During the comment period, comments
SUMMARY: In compliance with the grants to fund Outcomes Payments for
may be viewed online through FDMS.
Paperwork Reduction Act (PRA) of 1995 one or more PFS projects that seek to
FOR FURTHER INFORMATION CONTACT:
(44 U.S.C. 3501–3521), this notice improve employment outcomes for
Veterans with a Service-connected Brian McCarthy at (202) 461–6345.
announces that the Office of Policy and
Mental Health Disability. SUPPLEMENTARY INFORMATION: Under the
Planning (OPP), Department of Veterans
Affected Public: Individuals or PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
Affairs, will submit the collection of
households. 3501–3521), Federal agencies must
information abstracted below to the
Estimated Annual Burden: 2000 obtain approval from OMB for each
Office of Management and Budget
hours. collection of information they conduct
(OMB) for review and comment. The
Estimated Average Burden Per or sponsor. This request for comment is
PRA submission describes the nature of
Respondent: 80 minutes. being made pursuant to Section
the information collection and its
Frequency of Response: On occasion. 3506(c)(2)(A) of the PRA.
expected cost and burden; it includes
Estimated Number of Respondents: With respect to the following
the actual data collection instrument.
25. collection of information, VHA invites
The Federal Register Notice with a 60-
comments on: (1) Whether the proposed
day comment period soliciting By direction of the Secretary. collection of information is necessary
comments on this collection of Cynthia Harvey-Pryor, for the proper performance of VHA’s
information was published on VA Clearance Officer, Office of Privacy and functions, including whether the
November 3, 2016, Vol. 81, page 76699. Records Management, Department of information will have practical utility;
DATES: Comments must be submitted on Veterans Affairs. (2) the accuracy of VHA’s estimate of
or before February 27, 2017. [FR Doc. 2017–01743 Filed 1–25–17; 8:45 am] the burden of the proposed collection of
ADDRESSES: Submit written comments BILLING CODE 8320–01–P information; (3) ways to enhance the
on the collection of information through quality, utility, and clarity of the
www.Regulations.gov, or to Office of information to be collected; and (4)
Information and Regulatory Affairs, DEPARTMENT OF VETERANS ways to minimize the burden of the
Office of Management and Budget, Attn: AFFAIRS collection of information on
VA Desk Officer; 725 17th St. NW., [OMB Control No. 2900–NEW] respondents, including through the use
Washington, DC 20503 or sent through of automated collection techniques or
electronic mail to oira_submission@ Proposed Information Collection the use of other forms of information
omb.eop.gov. Please refer to ‘‘OMB Activity: (Income Verification) technology.
Control No. 2900–0847’’ in any Titles:
correspondence. AGENCY: Veterans Health a. Mailed with Veterans’ Initial
Administration, Department of Veterans Letters—HEC Form 200–1A
FOR FURTHER INFORMATION CONTACT: Affairs. b. Mailed with Spouses’ Initial
Cynthia Harvey-Pryor, Enterprise
ACTION: Notice. Letters—HEC Form 220–1
Records Service (005R1B), Department c. Mailed to Veterans When
of Veterans Affairs, 810 Vermont SUMMARY: The Veterans Health Necessary—HEC Form 340–1
Avenue NW., Washington, DC 20420, Administration (VHA) is announcing an d. Mailed to Veterans When
(202) 461–5870 or email cynthia.harvey- opportunity for public comment on the
jstallworth on DSK7TPTVN1PROD with NOTICES

Necessary—Checklist.
pryor@va.gov. Please refer to ‘‘OMB proposed collection of certain OMB Control Number: 2900–NEW.
Control No. 2900–0847.’’ information by the agency. Under the Type of Review: New collection.
SUPPLEMENTARY INFORMATION: Paperwork Reduction Act (PRA) of Abstract: The HEC, IVD uses HEC
Title: Veterans Employment Pay For 1995, Federal agencies are required to Form 200–1A (Veteran’s Income
Success (VEPFS), Grant Program publish notice in the Federal Register Verification Response) to collect income
Application. concerning each proposed collection of verification information, as applicable,
OMB Control Number: 2900–0847. information, including this new from the Veteran by requesting the

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Federal Register / Vol. 82, No. 16 / Thursday, January 26, 2017 / Notices 8567

Veteran to verify the listed income on a. Mailed with Veterans’ Initial extension of a currently approved
the form as reported to IVD by IRS/SSA, Letters—HEC Form 200–1A—89,001 collection, and allow 60 days for public
to select the appropriate option on the hours comment in response to the notice. This
form relating to the household income, b. Mailed with Spouses’ Initial notice solicits comments on information
attest to out of pocket medical expenses, Letters—HEC Form 220–1—28,530 needed to determine that training
attest to sale of primary home real estate hours programs (Apprenticeship and On-the-
and attest to separation from spouse for c. Mailed to Veterans When Job Training) and agreements meet the
the income year under the Income Necessary—HEC Form 340–1—1,701 statutory requirements for approval.
Verification Division’s review. The hours DATES: Written comments and
Veteran’s signature is required on page d. Mailed to Veterans When recommendations on the proposed
2 of HEC Form 200–1A. If the Veteran Necessary—Checklist—761 hours collection of information should be
has medical/health limitations that does Estimated Average Burden per received on or before March 27, 2017.
not enable the Veteran to physically Respondent:
ADDRESSES: Submit written comments
sign the form with a wet signature, the a. Mailed with Veterans’ Initial
on the collection of information through
Veteran must mark an ‘‘X’’ to designate Letters—HEC Form 200–1A—30
Federal Docket Management System
a signature; two witnesses must verify minutes
(FDMS) at www.Regulations.gov or to
the ‘‘X’’ as the Veteran’s signature. HEC, b. Mailed with Spouses’ Initial
Nancy J. Kessinger, Veterans Benefits
IVD will use the completed HEC Form Letters—HEC Form 220–1—20 minutes
Administration (20M33), Department of
200–1A to assist in verifying the c. Mailed to Veterans When
Veterans Affairs, 810 Vermont Avenue
Veteran’s correct gross household Necessary—HEC Form 340–1—15
NW., Washington, DC 20420 or email to
income to ensure the Veteran is placed minutes
nancy.kessinger@va.gov. Please refer to
in the correct priority group for health d. Mailed to Veterans When
‘‘OMB Control No. 2900–0342’’ in any
care. Necessary—Checklist—761—15 minutes
correspondence. During the comment
The HEC, IVD uses HEC Form 220–1 Frequency of Response: Annually.
period, comments may be viewed online
(Spouse’s Income Verification Estimated Annual Responses:
through the FDMS.
Response) to collect income verification a. Mailed with Veterans’ Initial
Letters—HEC Form 200–1A—178,002 FOR FURTHER INFORMATION CONTACT:
information, as applicable, from the
b. Mailed with Spouses’ Initial Nancy J. Kessinger at (202) 632–8924 or
Veteran’s spouse by requesting the
Letters—HEC Form 220–1—85,590 FAX (202) 632–8925.
spouse to verify the listed income on the
form as reported to IVD by IRS/SSA, c. Mailed to Veterans When SUPPLEMENTARY INFORMATION: Under the
report any additional income not Necessary—HEC Form 340–1—6,805 PRA of 1995 (Pub. L. 104–13; 44 U.S.C.
reported by IRS/SSA and sign and date d. Mailed to Veterans When 3501–21), Federal agencies must obtain
the form. If the spouse has medical/ Necessary—Checklist—761—3,044 approval from the Office of Management
health limitations that does not enable By direction of the Secretary. and Budget (OMB) for each collection of
the spouse to physically sign the form Cynthia Harvey-Pryor,
information they conduct or sponsor.
with a wet signature, the spouse must This request for comment is being made
Program Specialist, Office of Privacy and
mark an ‘‘X’’ to designate a signature; Records Management, Department of
pursuant to Section 3506(c)(2)(A) of the
two witnesses must verify the ‘‘X’’ as Veterans Affairs. PRA.
the Veteran’s signature. HEC, IVD will [FR Doc. 2017–01753 Filed 1–25–17; 8:45 am]
With respect to the following
use the completed HEC Form 220–1 to collection of information, VBA invites
BILLING CODE 8320–01–P
assist in verifying the Veteran’s correct comments on: (1) Whether the proposed
gross household income to ensure the collection of information is necessary
Veteran is placed in the correct priority DEPARTMENT OF VETERANS for the proper performance of VBA’s
group for health care. AFFAIRS functions, including whether the
The HEC, IVD uses the HEC Form information will have practical utility;
[OMB Control No. 2900–0342] (2) the accuracy of VBA’s estimate of the
340–1 (Declaration of Representative)
for the Veteran and the spouse (if burden of the proposed collection of
Agency Information Collection information; (3) ways to enhance the
applicable) to appoint a representative, Activity: (Application and Training
authorizing HEC, IVD to release quality, utility, and clarity of the
Agreement for Apprenticeship and On- information to be collected; and (4)
information to a designated appointee the-Job Training Programs) (VA Form
for a specific income year. Such ways to minimize the burden of the
22–8864; 22–8865)) collection of information on
information includes confidential
federal tax information, other income, AGENCY: Veterans Benefits respondents, including through the use
and medical benefits eligibility related Administration, Department of Veterans of automated collection techniques or
information. The Veteran and spouse (if Affairs. the use of other forms of information
applicable) must sign and date the form. ACTION: Notice.
technology.
Title: Application and Training
The HEC, IVD uses the HEC Income Agreement for Apprenticeship and On-
SUMMARY: The Veterans Benefits
Verification—Additional Information the-Job Training Programs, VA Form
Administration (VBA), Department of
Checklist to request from the Veteran 22–8864; 22–8865.
Veterans Affairs (VA), is announcing an
any additional information needed to OMB Control Number: 2900–0342.
opportunity for public comment on the
jstallworth on DSK7TPTVN1PROD with NOTICES

adjudicate the Income Verification case. Type of Review: Revision of a
proposed collection of certain
The Veteran providing the requested currently approved collection.
information by the agency. Under the
information usually results in the best
Paperwork Reduction Act (PRA) of Abstract: VA Forms 22–8864 and 22–
interest to the Veteran.
1995, Federal agencies are required to 8865 are used to collect information
Affected Public: Individuals or publish notice in the Federal Register from employers and trainees to ensure
households. concerning each proposed collection of that training programs (Apprenticeship
Estimated Annual Burden: information, including each proposed and On-the-Job Training) and

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Document Created: 2017-01-26 00:05:12
Document Modified: 2017-01-26 00:05:12

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 March 27, 2017.
Contact		Brian McCarthy at (202) 461-6345.
FR Citation		82 FR 8566