[Federal Register Volume 68, Number 87 (Tuesday, May 6, 2003)]
[Notices]
[Pages 24048-24050]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-11206]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0160]


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 extension of a currently approved collection, and allow 
60 days for public comment in response to the notice. This notice 
solicits comments on information needed to determine whether State 
homes providing nursing home care and adult day health care are 
providing high quality care to eligible veterans.

[[Page 24049]]


DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 7, 2003.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (193B1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail [email protected]. Please refer to ``OMB Control No. 2900-
0160'' 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.
    Titles:
    a. State Home Inspection, VA Form 10-3567.
    b. Instructions for State Home Report and Statement of Federal Aid 
Claimed, VA Form 10-5588.
    c. State Home Program Application for Veterans Care--Medical 
Certification, VA Form 10-10SH.
    d. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143.
    e. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043A.
    f. Certification Regarding Lobbying, VA Form 10-0144.
    g. Statement of Assurance of Compliance With Equal Opportunity Law, 
VA Form 10-144A.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52.
    OMB Control Number: 2900-0160.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA pays per diem to State homes providing adult day 
health care to eligible veterans. To ensure high quality care is 
furnished to the veterans, VA requires those facilities providing adult 
day health care to furnish an application for recognition based on 
certification; appeal information, application and justification for 
payment; records and reports which facility management must maintain 
regarding activities of residents or participants; information relating 
to whether the facility meets standards concerning residents' rights 
and responsibilities prior to admission or enrollment, during admission 
or enrollment, and upon discharge; the records and reports which 
facilities management and health care professionals must maintain 
regarding residents or participants and employees; documents pertain to 
the management of the facilities; food menu planning; pharmaceutical 
records; and life safety documentation. This information is necessary 
to ensure that VA per diem payments are limited to facilities providing 
high quality care to eligible veterans.
    Affected Public: State, local or tribal government, individuals or 
households, and not for profit institutions.
    Estimated Total Annual Burden: 15,886 hours.
    a. State Home Inspection, VA Form 10-3567--86 hours.
    b. Instructions for State Home Report and Statement of Federal Aid 
Claimed, VA Form 10-5588--1,026 hours.
    c. State Home Program Application for Veterans Care--Medical 
Certification, VA Form 10-10SH--10,565 hours.
    d. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--21 hours.
    e. Statement of Assurance of Compliance With Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043A--21 hours.
    f. Certification Regarding Lobbying, VA Form 10-0144--21 hours.
    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-144A--21 hours.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52--4,125 hours.
    Estimated Average Burden Per Respondent:
    a. State Home Inspection, VA Form 10-3567--30 minutes.
    b. Instructions for state Home Report and Statement of Federal Aid 
Claimed, VA Form 10-5588--30 minutes.
    c. State Home Program Application for Veterans Care--Medical 
Certification, VA Form 10-10SH--30 minutes.
    d. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--7 minutes.
    e. Statement of Assurance of Compliance With Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043A--7 minutes.
    f. Certification Regarding Lobbying, VA Form 10-0144--7 minutes.
    g. Statement of Assurance of Compliance With Equal Opportunity Law, 
VA Form 10-144A--7 minutes.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52--7 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 43,157.
    a. State Home Inspection, VA Form 10-3567--171.
    b. Instructions for State Home Report and Statement of Federal Aid 
Claimed, VA Form 10-5588--171.
     c. State Home Program Application for Veterans Care--Medical 
Certification, VA Form 10-10SH--21,129.
    d. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--171.
    e. Statement of Assurance of Compliance With Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043A--171.
    f. Certification Regarding Lobbying, VA Form 10-0144--171.
    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-144A--171.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52--21,002.
    Estimated Total Annual Responses: 45,521.
    a. State Home Inspection, VA Form 10-3567--171.
    b. Instructions for State Home Report and Statement of Federal Aid 
Claimed, VA Form 10-5588--2,052.
    c. State Home Program Application for Veterans Care--Medical 
Certification, VA Form 10-10SH--21,129.
    d. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--171.

[[Page 24050]]

    e. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043A--171.
    f. Certification Regarding Lobbying, VA Form 10-0144--171.
    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-144A--171.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52--21,485.

    Dated: April 24, 2003.

    By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-11206 Filed 5-5-03; 8:45 am]
BILLING CODE 8320-01-P