[Federal Register Volume 62, Number 176 (Thursday, September 11, 1997)] [Notices] [Pages 47879-47880] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 97-24063] ----------------------------------------------------------------------- DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0091] Agency Information Collection Activities Under OMB Review AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501 et seq.), this notice announces that the Veterans Health Administration (VHA), Department of Veterans Affairs, has submitted 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 October 14, 1997. FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT: Ron Taylor, Information Management Service (045A4), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8015 or FAX (202) 273-5981. Please refer to ``OMB Control No. 2900-0091.'' SUPPLEMENTARY INFORMATION: Title and Form Numbers: Application for Medical Benefits, VA Forms 10-10 and 10-10T; 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 OMB approvals for use of these forms is due to expire on August 31, 1997. Many of these forms will be redesigned to meet the requirements of Public Law 104-262, Veterans' Health Care Eligibility Reform Act of 1996. VHA is requesting an extension until such time as these forms [[Page 47880]] are designed and the enrollment process is implemented. Title 38, U.S.C., Chapter 17, authorized VA to provide hospital care, medical services, domiciliary care and nursing home care to eligible veterans. Public Law 99-272 amending Title 38, U.S.C., Section 1729, established new eligibility assessment procedures, based on income levels, for determining whether nonservice-connected veterans are eligible for cost-free VA medical care and authorizes VA to recover the cost of care furnished to veterans from their health insurance carriers. Public Law 99-272 codified at Title 38, U.S.C., Section 1722, authorized VA to provide care to nonservice-connected veterans who are unable to defray the necessary expenses of care if the veteran's attributable income is not greater than the maximum annual pension rate. Title 38 U.S.C., Section 1722a, authorizes collection of a co- payment for medications. Public Law 104-262 requires VA to design, establish and operate a system of annual patient enrollment in accordance with a series of priorities stipulated in the law. A consequence of this law is that many groups of veterans who are in a lower priority group (W.W.I veterans, veterans with disabilities rated as 0% service-connected seeking treatment for other than their service connected conditions, veterans exposed to a toxic substance, radiation, or environmental hazard and nonservice-connected veterans) may request that they be allowed to be income tested in order to gain a higher priority. Title 38, U.S.C., Chapters 23 and 24, authorizes VA to provide burial benefits and to bury the remains of an eligible deceased veteran in a National Cemetery. VA Forms 10-10, 10-10T, 10-10F, and 10-10I are generally completed by clerical staff at the VHA medical facility where the applicant applies for medical care benefits; however, the forms may be completed by veterans in the convenience of their home. If the veteran is completing the forms at home and it is the first time application is made, the forms are submitted to the nearest VA health care facility for processing. VA Form 10-2065 is generally completed by clerical staff at the medical center upon the death of a veteran in a VA medical care facility. VA Form 10-10 is used to establish a system of records on veterans applying for medical care benefits. The information collected is used to identify the veteran applying for medical care, emergency contact data, employment information, military service data, and income screening data for pharmacy co-payment authorized under Title 38, U.S.C., Section 1722A. This also includes the ``missing'' VA Form 10- 10T data collected at a later date. VA Form 10-10T is a simplified version of VA Form 10-10 and was created to shorten the application process. VA Form 10-10T is used to identify the veteran applying for medical care, establish a veteran's initial eligibility and establish a system of records on veterans applying for medical care benefits. If the veteran is eligible for care, any missing data which in the past would have been collected on VA Form 10-10, such as an emergency contacts, employment information, military service data, and income screening data for pharmacy co- payment authorized under Title 38, U.S.C., Section 1722A is collected at a later date. VA Form 10-10F is used in the information collection process to obtain financial information on all 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. VA Form 10-10I is used in the information collection process to collect health insurance information and to bill health insurance carriers to recover the cost of medical care furnished to veterans for treatment on nonservice-connected conditions. VA Form 10-2065 is used primarily in VA medical facilities and 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 place of burial, and/or when burial is requested in a National Cemetery. This information is requested under the authority of Title 38, U.S.C., Chapters 23 and 24. 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 May 27, 1997 at page 28757-28758. Affected Public: Individuals or households. Estimated Annual Burden: 2,766,738 hours. VA Form 10-10--1,631,250 hours VA Form 10-10T--60,417 hours VA Form 10-10F--492,000 hours VA Form 10-10I--480,000 hours VA Form 10-2065--3,071 hours Estimated Average Burden Per Respondent. VA Form 10-10--45 minutes VA Form 10-10T--5 minutes VA Form 10-10F--20 minutes VA Form 10-10I--12 minutes VA Form 10-2064--5 minutes Frequency of Response: On occasion. Estimated Number of Respondents: 7,336,850. VA Form 10-10--2,175,000 VA Form 10-10T--725,000 VA Form 10-10F--1,500,000 VA Form 10-10I--2,900,000 VA Form 10-2064--34,850 Send commends and recommendations concerning any aspect of the information collection 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. Please refer to ``OMB Control No. 2900-0091'' in any correspondence. Dated: August 12, 1997. By direction of the Secretary. Donald L. Neilson, Director, Information Management Service. [FR Doc. 97-24063 Filed 9-10-97; 8:45 am] BILLING CODE 82320-01-M