[Federal Register Volume 61, Number 225 (Wednesday, November 20, 1996)]
[Notices]
[Page 59138]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-29622]


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DEPARTMENT OF VETERANS AFFAIRS

Agency Information Collection: Submission for OMB Review; Comment 
Request

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Benefits Administration (VBA), Department of 
Veterans Affairs, has submitted to the Office of Management and Budget 
(OMB) the following proposal for the collection of information under 
the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35).
    OMB Control Number: 2900-0104.
    Title and Form Number: Report of Accidental Injury in Support of 
Claim for Compensation or Benefits, VA Form 21-4176.
    Type of Review: Extension of a currently approved collection.
    Need and Uses: The form is used in support of claims for disability 
benefits based on a disability which is the result of an accident. The 
information given by the veteran is used as a source to gather specific 
data regarding the accident and to afford the veteran an opportunity to 
provide information from his or her own knowledge regarding the 
accident.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,200 hours.
    Estimated Average Burden Per Respondent: 30 minutes.
    Frequency of Response: On occasion
    Estimated Number of Respondents: 4,400.

ADDRESSES: A copy of this submission may be obtained from Ron Taylor, 
VA Clearance Officer (045A4), Department of Veterans Affairs, 810 
Vermont Avenue, NW, Washington, DC 20420, (202) 273-8015.
    Comments and recommendations concerning the submission should be 
directed to VA's OMB Desk Officer, Allison Eydt, OMB Human Resources 
and Housing Branch, New Executive Office Building, Room 10235, 
Washington, DC 20503 (202) 395-4650. DO NOT send requests for benefits 
to this address.

DATES: Comments on the information collection should be directed to the 
OMB Desk Officer on or before December 20, 1996.

FOR FURTHER INFORMATION CONTACT: Ron Taylor, VA Clearance Officer 
(045A4), (202) 273-8015.

    Dated: October 31, 1996.

    By direction of the Secretary.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 96-29622 Filed 11-19-96; 8:45 am]
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