[Federal Register Volume 68, Number 106 (Tuesday, June 3, 2003)]
[Notices]
[Pages 33228-33229]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-13895]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New--Foreign Medical]


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 new collection, and allow 60 days for public comment in 
response to the notice. This notice solicits comments on information 
needed to claim reimbursement for medical services outside the United 
States (except Canada and the Philippines) for service-connected 
disability.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before August 4, 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-
New--Foreign Medical'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Public Law 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: Claim Cover Sheet for Foreign Medical 
Program, VA Form 10-7959f.
    OMB Control Number: 2900-New--Foreign Medical.
    Type of Review: New collection.
    Abstract: VA Form 10-7959f will be used for submitting claims for 
payment/reimbursement of expenses related to veterans who are residing 
or traveling overseas (except for Canada and the Philippines) with a 
service-connected disability. The form outlines the basic veteran 
information necessary for consideration of claims for reimbursement. 
Use of this form by providers or veteran is optional. VA accepts 
provider generated billing statement, Uniform Billing-Forms (UB) 92, 
HCFA 1500, Medicare Health Insurance Claims Form. This information 
collection is needed to carry out the health care benefits allowed by 
the Foreign Medical Program.
    Affected Public: Individuals or households, Business or other for 
profit, and Not for profit institutions.
    Estimated Total Annual Burden: 3,652 hours.
    Estimated Average Burden Per Respondent: 11 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 1,660.

[[Page 33229]]

    Estimated Total Annual Responses: 19,920.

    Dated: May 20, 2003.
    By direction of the Secretary:
Martin L. Hill,
Acting Director, Records Management Service.
[FR Doc. 03-13895 Filed 6-2-03; 8:45 am]
BILLING CODE 8320-01-P