[Federal Register Volume 64, Number 246 (Thursday, December 23, 1999)]
[Notices]
[Pages 72144-72145]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-33249]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0335]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

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, without change, 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 the 
information needed to authorize a veteran to seek a private dentist for 
dental examination and treatment plan and to authorize payment for such 
dental services.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before February 22, 2000.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (191A1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420. Please 
refer to ``OMB Control No. 2900-0335'' 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) ways 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 Number: Dental Record Authorization and Invoice for 
Outpatient Services, VA Form 10-2570d.
    OMB Control Number: 2900-0335.
    Type of Review: Reinstatement, without change, of a previously 
approved collection for which approval has expired.
    Abstract: VA Form 10-2570d is used to serve the following multi-
purposes: (1) VA authorization to the veteran to seek a private dentist 
for examination; (2) Fee dentist's record of examination

[[Page 72145]]

findings; (3) Dentist's treatment plan and listing of services needed; 
(4) Listing of dentist's usual and customary fees for specific services 
involved in treatment plan; (5) VA review, verification and 
authorization of treatment to the fee dentist; (6) Dentist's 
certification of services completed; (7) VA's permanent record of 
treatment provided for veterans and statement of exhaustion of 
benefits, if indicated; VA's approval of dental services and total fees 
for payment; and (8) Fiscal approval and certification of payment and 
amount. Without this information, veterans' dental treatment needs 
could not be identified, fees for services could not be established, 
the veterans could not receive treatment, and the fee dentist could not 
be reimbursed.
    Affected Public: Business or other for profit.
    Estimated Total Annual Burden: 14,333 hours.
    Estimated Average Burden Per Respondent: 20 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 43,000.

    Dated: December 3, 1999.

    By direction of the Secretary.
Sandra McIntyre,
Program Analyst, Information Management Service.
[FR Doc. 99-33249 Filed 12-22-99; 8:45 am]
BILLING CODE 8320-01-P