[Federal Register Volume 68, Number 161 (Wednesday, August 20, 2003)]
[Notices]
[Pages 50218-50219]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-21233]


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DEPARTMENT OF VETERANS AFFAIRS

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


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.

DATE: 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) 273-8130 
or FAX (202) 273-5981, or e-mail: [email protected]. Please 
refer to ``OMB Control No. 2900--New--Foreign Medical.''
    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--New--Foreign Medical'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Title: 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 to submit 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

[[Page 50219]]

Insurance Claims Form. This information collection is needed to carry 
out the health care benefits allowed by the Foreign Medical Program.
    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 June 3, 2003, at pages 33228-33229.
    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.
    Estimated Total Annual Responses: 19,920.

    Dated: August 8, 2003.

    By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-21233 Filed 8-19-03; 8:45 am]
BILLING CODE 8320-01-P