[Federal Register Volume 69, Number 21 (Monday, February 2, 2004)]
[Notices]
[Page 4986]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-2041]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0335]


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. 3501-21), 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 and includes the actual data collection instrument.

DATES: Comments must be submitted on or before March 3, 2004.

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. 2900-0335.''
    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. 
2900-0335'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Title: Dental Record Authorization and Invoice for Outpatient 
Services, VA Form 10-2570d.
    OMB Control Number: 2900-0335.
    Type of Review: Extension 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.
    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 October 14, 2003, at pages 59243-59244.
    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: January 15, 2004.

    By direction of the Secretary:
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 04-2041 Filed 1-30-04; 8:45 am]
BILLING CODE 8320-01-P