[Federal Register Volume 69, Number 106 (Wednesday, June 2, 2004)]
[Notices]
[Page 31158]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-12390]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0080]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

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 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 extension of a currently approved collection, and allow 60 days 
for public comment in response to the notice. This notice solicits 
comments on information needed to initiate and document expenditures, 
claim reimbursement as well as make funeral arrangements and authorize 
burial benefits.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before August 2, 2004.

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-
0080'' 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. 3501-3521), 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. Claim for Payment of Cost of Unauthorized Medical Services, VA 
Form 10-583.
    b. Funeral Arrangements, VA Form 10-2065.
    c. Authority and Invoice for Travel by Ambulance or Other Hired 
Vehicle, VA Form 10-2511.
    d. Authorization and Invoice for Medical and Hospital Services.
    OMB Control Number: 2900-0080.
    Type of Review: Extension of a currently approved collection.
    Abstract:
    a. VA Form 10-583 is used by health care providers as a claim for 
the cost of unauthorized hospital care and by veterans as a claim for 
reimbursement of such cost.
    b. VA Form 10-2065 is completed by clerical staff upon the death of 
a veteran in a VA medical care facility. It is used primarily in VA 
medical facilities and serves as an official record of the Funeral 
Director to which the person making funeral arrangements wishes the 
remains to be released. It is also used as a control document when VA 
is requested to arrange for the transportation of the deceased from the 
place of death to the place of burial, and/or when burial is requested 
in a National Cemetery.
    c. VA Form 10-7078 is used by administrative personnel in VA 
medical facilities to authorize expenditures from the medical care 
account and process payment of medical and hospital services provided 
by other than Federal health providers to VA beneficiaries.
    d. VA Form 10-2511 is used by administrative personnel in VA 
facilities to authorize expenditures from the beneficiary travel 
account. It is also used to process payment for ambulance or other 
hired vehicular forms of transportation for eligible veterans to and 
from VA health care facilities for examination, treatment or care.
    Affected Public: Business or other for profit, individuals or 
households, and not for profit institutions.
    Estimated Total Annual Burden: 31,546 hours.
    a. VA Form 10-583--17,188.
    b. VA Form 10-2065--3,625.
    c. VA Form 10-2511--2,333.
    d. VA Form 10-7078--8,400.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-583--15 minutes.
    b. VA Form 10-2065--5 minutes.
    c. VA Form 10-2511--2 minutes.
    d. VA Form 10-7078--2 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 434,250.
    a. VA Form 10-583--68,750 respondents.
    b. VA Form 10-2065--43,500 respondents.
    c. VA Form 10-2511--70,000 respondents.
    d. VA Form 10-7078--252,000 respondents.

    Dated: May 19, 2004.

    By direction of the Secretary.
Loise Russell,
Director, Records Management Service.
[FR Doc. 04-12390 Filed 6-1-04; 8:45 am]
BILLING CODE 8320-01-P