[Federal Register Volume 69, Number 110 (Tuesday, June 8, 2004)]
[Notices]
[Pages 32096-32097]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-12949]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0260]


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 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 on the need to obtain written consent from a patient 
to disclose his or her medical record to private insurance companies, 
physicians and other third party.

DATES: Written comments and recommendations on the proposed

[[Page 32097]]

collection of information should be received on or before August 9, 
2004.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (19E1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail [email protected]. Please refer to ``OMB Control No. 2900-
0260'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 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.
    Title: Request for and Consent to Release of Medical Records 
Protected by 38 U.S.C. 7332, VA Form 10-5345.
    OMB Control Number: 2900-0260.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 10-5345 is used to obtain prior written consent 
from a patient before information concerning treatment for alcoholism 
or alcohol abuse, drug abuse, sickle cell anemia, or infection with the 
human immunodeficiency virus (HIV) can be disclosed from his or her 
medical record. This special consent must indicate the name of the 
facility permitted to make the disclosure, name of the individual or 
organization to whom the information is being released, specify the 
particular records or information to be released, and be under the 
signature of the veteran and dated. It must reflect the purpose the 
information is to be used, and include a statement that the consent is 
subject to revocation and the date, event or condition upon which the 
consent will expire if not revoked before.
    VA personnel complete 50 percent of the form and the patient 
completes the remaining 50 percent. If VA did not collect this 
information, the information could not be released from the patient's 
records. This would have a negative impact on patients who need and 
want information released to private insurance companies, physicians 
and other third parties.
    Affected Public: Business or other for profit and Individuals or 
households.
    Estimated Total Annual Burden: 16,667 hours.
    Estimated Average Burden Per Respondent: 2 minutes.
    Frequency of Response: One-time.
    Estimated Number of Respondents: 500,000.

    Dated: May 28, 2004.

    By direction of the Secretary:
Loise Russell,
Director, Records Management Service.
[FR Doc. 04-12949 Filed 6-7-04; 8:45 am]
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