[Federal Register Volume 68, Number 198 (Tuesday, October 14, 2003)]
[Notices]
[Pages 59243-59244]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-25836]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0335]


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

[[Page 59244]]

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 revision of a 
currently approved collection, and allow 60 days for public comment in 
response to the notice. This notice solicits comments on the 
information needed to determine a veteran's dental treatment needs, and 
the fees associated for these services.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before December 15, 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-
0335'' 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. 3501-21), 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: Dental Record Authorization and Invoice for Outpatient 
Services, VA Form 10-2570d.
    OMB Control Number: 2900-0335.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA Form 10-2570b, Examination Procedure Instructions for 
Participating Fee Dentist, and VA Form 10-2570c, Treatment Procedure 
Instructions for the Participating Fee Dentist, have been combined with 
VA Form 10-2570d, Dental Record Authorization and Invoice for 
Outpatient Services. VA Form 10-2570d is essential to the proper 
administration of VA outpatient fee dental program. The associated 
instructions make it possible to communicate with clarity the required 
procedures, peculiarities, and precautions associated with VA 
authorizations for contracting with private dentists for the provision 
of dental treatment for eligible veteran beneficiaries. Since most of 
the veterans who are authorized fee dental care are geographically 
inaccessible to VA dental clinics, it is necessary to request 
information as to the veteran's oral condition, treatment needs and the 
usual customary fees for these services from the private fee dentist 
whom the veteran has selected. The form lists the dental treatment 
needs of the veteran patient, the cost to VA to provide such services, 
and serves as an invoice for payment.
    Affected Public: Business and other for profit.
    Estimated Total Annual Burden: 4,153 hours.
    Estimated Average Burden Per Respondent: 20 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 12,460.

    Dated: October 2, 2003.

By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-25836 Filed 10-10-03; 8:45 am]
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