[Federal Register Volume 63, Number 9 (Wednesday, January 14, 1998)]
[Notices]
[Page 2302]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-827]



[[Page 2302]]

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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0080]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request

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 reinstatement of a previously approved collection for 
which approval has expired, and allow 60 days for public comment in 
response to the notice. This notice solicits comments on information 
needed to claim payment for reimbursement and to authorize and process 
payment of medical and hospital services provided by a non-Federal 
provider; and to authorize use of and process payment for ambulance and 
other hired vehicle.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before March 16, 1998.

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. 2900-0080'' 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: Claim for Payment of Cost of Unauthorized Medical Service, 
Authority and Invoice for Travel by Ambulance or Other Hired Vehicle, 
and Authorization and Invoice for Medical and Hospital Services.
    Form Numbers:
    a. VA Form 10-583, Claim for Payment of Cost of Unauthorized 
Medical Service.
    b. VA Form 10-2511, Authority and Invoice for Travel by Ambulance 
or Other Hired Vehicle.
    c. VA Form 10-7078, Authorization and Invoice for Medical and 
Hospital Services.
    OMB Control Number: 2900-0080.
    Type of Review: Reinstatement, without change, of a previously 
approved collection for which approval has expired.
    Abstract:
    a. VA Form 10-583 is used by administrative personnel in VA medical 
facilities of fee jurisdiction to collect information for determining 
legal and medical eligibility of applicants for payment or 
reimbursement of the costs of unauthorized medical services obtained by 
a veteran. The form is completed by the applicant as an official claim 
for such benefits and by VA officials to certify the authorized payment 
or reimbursement and to authorize such payment. If the collection of 
information was not carried out, VA's ability to provide reimbursement 
or payment for these costs would be negated.
    b. Administrative personnel in VA medical facilities to authorize 
expenditures from the beneficiary trust account use VA Form 10-2511. It 
is also used to process payment for ambulance or other hired vehicular 
forms of transportation to eligible veterans to and from VA health care 
facilities for examination, treatment or care. If the collection of 
information was not conducted, payment to vendors for services rendered 
would not be possible.
    c. VA Form 10-7078 is used by administrative personnel in VA 
medical facilities to authorize expenditures from the medical care 
account and process payment of medical and hospital services provided 
by other than Federal health providers to VA beneficiaries. Without the 
use of this form it would complicate management and record keeping of 
expenditures for medical care provided at VA expense by the private 
sector.
    Affected Public: Business or other for-profit--Individuals or 
households--Not-for-profit institutions--State, Local or Tribal 
Government.
    Estimated Total Annual Burden: 29,671 hours.
    a. VA Form 10-583--17,188 hours.
    b. VA Form 10-2511--4,083 hours.
    c. VA Form 10-7078--8,400 hours.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-583--15 minutes.
    b. VA Form 10-2511--2 minutes.
    c. VA Form 10-7078--2 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 443,250.
    a. VA Form 10-2421--68,750.
    b. VA Form 10-2520--122,500.
    c. VA Form 10-2914--252,000.

    Dated: December 10, 1997.

    By direction of the Secretary
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 98-827 Filed 1-13-98; 8:45 am]
BILLING CODE 8320-01-P