[Federal Register Volume 62, Number 101 (Tuesday, May 27, 1997)]
[Notices]
[Pages 28757-28758]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-13712]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0091]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request; Revision

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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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 
each proposed revision of a currently approved collection, and allow 60 
days for public comment in response to the notice. This notice solicits 
comments on requirements relating to the collection of information from 
veterans during the medical care application process and when making 
funeral and burial arrangements.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 28, 1997.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (161A1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420. Please 
refer to ``OMB Control No. 2900-0091'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C., 3501-3520), 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, 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) way 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.
    Title and Form Numbers: Application for Medical Benefits, VA Form 
10-10; Insurance Information, VA Form 10-10I; Financial Worksheet, VA 
Form 10-10F; and Funeral Arrangements, VA Form 10-2065.
    OMB Control Number: 2900-0091.
    Type of Review: Revision of a currently approved collection.
    Abstract: The forms are used to collect information in connection 
with providing medical care benefits, obtaining health insurance 
information for third party billing purposes, obtaining income and 
asset information, and for the purposes of making funeral and burial 
arrangements for deceased veterans. The purpose of the collection of 
information is outlined below:
    a. VA Form 10-10 is used to establish a system of records on 
veterans applying for medical benefits. The information is used to 
identify the veterans applying for medical care, establish initial 
eligibility for care, and to provide emergency contacts, employment 
information, military service data, and income screening for pharmacy 
co-payment.
    b. VA Form 10-10F is used to collect financial information on 
veterans whose eligibility for VA health care benefits is based on 
income. Nonservice-connected veterans and noncompensable service-
connected veterans rated 0% seeking care for their nonservice-connected 
conditions complete the form to establish their eligibility for cost-
free health care, mileage reimbursement and prescription co-payment 
exemption benefits. Veterans with compensable service-connected 
disabilities rated 0, 10 or 20% may provide their income information to 
establish their eligibility for prescription co-payment exemption and 
mileage reimbursement. Veterans with service-connected disabilities 
rated 30 or 40% may provide their income information to determine their 
eligibility for prescription co-payment exemption.
    c. VA Form 10-10I is used to collect health insurance information 
and to bill health insurance carries to recover the cost of medical 
care furnished to veterans for treatment of nonservice-connected 
conditions.
    d. VA Form 10-2065 serves as an official record of the funeral 
director to which the person making funeral arrangements wishes the 
remains to be released. It is used as a control document when VA is 
requested to arrange for the transportation of the deceased from the 
place of death to the

[[Page 28758]]

place of burial, and/or when burial is requested in a National 
Cemetery.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 3,212,738 hours.
    a. VA Form 10-10--2,175,000 hours.
    b. VA Form 10-10F--454,667 hours.
    c. VA Form 10-10I--580,000 hours.
    d. VA Form 10-2065--3,071 hours.
    Estimated Average Burden Per Respondent: 21 minutes.
    a. VA Form 10-10--45 minutes.
    b. VA Form 10-10F--20 minutes.
    c. VA Form 10-10I--12 minutes.
    d. VA Form 10-2064--5 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 7,198,850.
    a. VA Form 10-10--2,900,000.
    b. VA Form 10-10F--1,364,000.
    c. VA Form 10-10I--2,900,000.
    d. VA Form 10-2064--34,850.

    Dated: May 15, 1997.

    By direction of the Secretary.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 97-13712 Filed 5-23-97; 8:45 am]
BILLING CODE 8320-01-P