[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]


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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.

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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]
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