[Federal Register Volume 68, Number 222 (Tuesday, November 18, 2003)]
[Notices]
[Pages 65116-65117]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-28679]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0616]


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), Department of 
Veterans Affairs (VA), 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 extension 
of a currently approved collection, and allow 60 days for public 
comment in response to the notice. This notice solicits comments for 
information needed to determine non-Federal nursing home or the 
residential care home qualification for providing care to veteran 
patients.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before January 20, 2004.

ADDRESSES: Submit written comments on the collection of information to 
Ann W. Bickoff, Veterans Health Administration (193B1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420. Please 
refer to ``OMB Control No. 2900-0616'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann W. Bickoff (202) 273-8310 or FAX 
(202) 273-9381.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Public Law 104-13; 44 
U.S.C. 3501-3521), 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.
    Titles:
    a. Application for Furnishing Nursing Home Care to Beneficiaries of 
Veterans Affairs, VA Form 10-1170.
    b. Residential Care Home Program--Sponsor Application, VA Form 10-
2407.
    OMB Control Number: 2900-0616.
    Type of Review: Extension of a currently approved collection.
    Abstract:

[[Page 65117]]

    a. VA Form 10-1170 is an application used by nursing homes wishing 
to provide nursing home care to veterans who receive VA benefits. It 
gives the nursing home the opportunity to describe the building and its 
capacity, staffing, structure and programming.
    b. VA Form 10-2407 is an application used by a residential care 
facility or home that wishes to provide residential home care to 
veterans. It serves as the agreement between VA and the residential 
care home that the home will submit to an initial inspection and comply 
with VA requirements for residential care.
    Affected Public: Business or other for-profit, Not-for-profit 
institutions, and State, Local or Tribal Government.
    Estimated Annual Burden:
    a. VA Form 10-1170--167 hours.
    b. VA Form 10-2407--83 hours.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-1170--20 minutes.
    b. VA Form 10-2407--5 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents:
    a. VA Form 10-1170--500.
    b. VA Form 10-2407--1,000.

    Dated: November 5, 2003.

    By direction of the Secretary.
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 03-28679 Filed 11-17-03; 8:45 am]
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