[Federal Register Volume 63, Number 68 (Thursday, April 9, 1998)]
[Notices]
[Page 17487]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-9318]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0080]


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 May 11, 1998.

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. 2900-0080.''

SUPPLEMENTARY INFORMATION:

    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 were 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 would complicate management and record keeping of 
expenditures for medical care provided at VA expense by the private 
sector.
    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 January 14, 1998 at page 2302.
    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.
    Send comments 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. 2900-0080'' in any correspondence.

    Dated: March 16, 1998.

    By direction of the Secretary.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 98-9318 Filed 4-8-98; 8:45 am]
BILLING CODE 8320-01-P