[Federal Register Volume 68, Number 161 (Wednesday, August 20, 2003)]
[Notices]
[Pages 50217-50218]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-21231]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0642]


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 September 19, 2003.

FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT: Denise 
McLamb, Records Management Service (005E3), Department of Veterans 
Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8030, 
FAX (202) 273-5981 or e-mail to: [email protected]. Please 
refer to ``OMB Control No. 2900-0642.''
    Send comments and recommendations concerning any aspect of the 
information collection to VA's OMB Desk Officer, OMB Human Resources 
and Housing Branch, New Executive Office Building, Room 10235, 
Washington, DC 20503, (202) 395-7316. Please refer to ``OMB Control No. 
2900-0642'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Title: VA Copayment Refund--USAA/Hartford Claim Form, VA Form 10-
0406.

[[Page 50218]]

    OMB Control Number: 2900-0642.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 10-0406 will be used to reimburse veterans 
insured by USAA/Hartford Life Insurance for co-payments they paid to VA 
for medical care from January 1, 1995 through December 31, 2001. Such 
insured veterans will have a one year time period from the initial 
notification date on a first-come-first-served basis, to file claim 
with VA for refund of their co-payments. The information collected will 
be used to determine the validity of such claims.
    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 April 3, 2003, at page 16349.
    Affected Public: Individuals or households.
    Estimated Total Annual Burden: 12,000 hours.
    Estimated Average Burden Per Respondent: 30 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 24,000.

    Dated: August 8, 2003.

    By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-21231 Filed 8-19-03; 8:45 am]
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