[Federal Register Volume 68, Number 161 (Wednesday, August 20, 2003)]
[Notices]
[Pages 50219-50220]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-21234]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0160]


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, Information Management Service (045A4), 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. 2900-0160.''
    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. 
2900-0160'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Titles:
    a. State Home Inspection--Staffing Profile, VA Form 10-3567.
    b. 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 10-0144A.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR part 52, and Per Diem for Nursing Home Care of Veterans in State 
Homes, 38 CFR parts 17, 51, and 48.
    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 pertaining 
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.
    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 May 6, 2003, at pages 24048-24050.
    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--Staffing Profile, VA Form 10-3567--86 
hours.
    b. 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 10-0143A--21 hours.
    f. Certification Regarding Lobbying, VA Form 10-0144--21 hours.
    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-0144A--21 hours.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52, and Per Diem for Nursing Home Care of Veterans in State 
Homes, 38 CFR Parts 17, 51, and 48--4,125 hours.
    Estimated Average Burden Per Respondent:
    a. State Home Inspection--Staffing Profile, VA Form 10-3567--30 
minutes.
    b. 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 10-0143A--7 minutes.
    f. Certification Regarding Lobbying, VA Form 10-0144--7 minutes.

[[Page 50220]]

    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-0144A--7 minutes.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52, and Per Diem for Nursing Home Care of Veterans in State 
Homes, 38 CFR Parts 17, 51, and 48--7 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 43,157.
    a. State Home Inspection--Staffing Profile, VA Form 10-3567--171.
    b. 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 10-0143A--171.
    f. Certification Regarding Lobbying, VA Form 10-0144--171.
    g. Statement of Assurance of Compliance with Equal Opportunity Law, 
VA Form 10-0144A--171.
    h. Per Diem for Adult Day Health Care of Veterans in State Homes, 
38 CFR Part 52, and Per Diem for Nursing Home Care of Veterans in State 
Homes, 38 CFR Parts 17, 51, and 48--21,002.

    Dated: July 28, 2003.

    By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-21234 Filed 8-19-03; 8:45 am]
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