[Federal Register Volume 69, Number 110 (Tuesday, June 8, 2004)]
[Notices]
[Page 32098]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-12951]



[[Page 32098]]

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

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0188]


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 proposed 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 determine eligibility and 
authorize funding for various prosthetic services.

DATES: Written comments and recommendations on the proposed 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-
0188'' 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.
    Titles:
    a. Request to Submit Estimate, Form Letter 10-90.
    b. Loan Follow-up Letter, Form Letter 10-426.
    c. Veterans Application for Assistance in Acquiring Home 
Improvement and Structural Alterations, VA Form 10-0103.
    d. Application for Adaptive Equipment Motor Vehicle, VA Form 10-
1394.
    e. Prosthetic Authorization for Items or Services, VA Form 10-2421.
    f. Prosthetic Service Card Invoice, VA Form 10-2520.
    g. Prescription and Authorization for Eyeglasses, VA Form 10-2914.
    OMB Control Number: 2900-0188.
    Type of Review: Extension of a currently approved collection.
    Abstract: The following forms will be used to determine 
eligibility, prescribe, authorize prosthetic devices, and obtain 
follow'up information on loaned prosthetic items, glasses, and 
adaptation to house and automobile:
    a. VA Form Letter 10-90 is used to obtain to estimated price for 
prosthetic devices.
    b. Form Letter 10-426 is used to inventory prosthetic devices 
loaned to eligible veterans. The form letter inventories the loaned 
items and solicits information from the beneficiary to determine the 
current status, the need to replace, extend the loan period or 
terminate the loaned items.
    c. VA Form 10-0103 is used to determine eligibility/entitlement and 
reimbursement of individual claims for home improvement and structural 
alterations.
    d. VA Form 10-1394 is used to determine eligibility/entitlement and 
reimbursement of individual claims for automotive adaptive equipment.
    e. VA Form 10-2421 is used for the direct procurement of new 
prosthetic appliances and/or services. The form standardizes the direct 
procurement authorization process, eliminating the need for separate 
purchase orders, expedites patient treatment and improves the delivery 
of prosthetic services.
    f. VA Form 10-2520 is used by the vendors as an invoice and billing 
document. The form standardizes repair/treatment invoices for 
prosthetic services rendered and standardizes the verification of these 
invoices. The veteran certifies that the repairs were necessary and 
satisfactory. This form is furnished to vendors upon request.
    g. VA Form 10-2914 is used as a combination prescription, 
authorization and invoice for eyeglasses.
    Affected Public: Business or other for profit and Individuals or 
households.
    Estimated Total Annual Burden: 48,522 hours.
    a. Form Letter 10-90--708.
    b. Form Letter 10-426--17.
    c. VA Form 10-0103--583.
    d. VA Form 10-1394--2,500.
    e. VA Form 10-2421--4,667.
    f. VA Form 10-2520--47.
    g. VA Form 10-2914--40,000.
    Estimated Average Burden Per Respondent:
    a. Form Letter 10-90--5 minutes.
    b. Form Letter 10-426--1 minute.
    c. VA Form 10-0103--5 minutes.
    d. VA Form 10-1394--15 minutes.
    e. VA Form 10-2421--4 minutes.
    f. VA Form 10-2520--4 minutes.
    g. VA Form 10-2914--4 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 697,200.
    a. Form Letter 10-90--8,500.
    b. Form Letter 10-426--1,000.
    c. VA Form 10-0103--7,000.
    d. VA Form 10-1394--10,000.
    e. VA Form 10-2421--70,000.
    f. VA Form 10-2520--700.
    g. VA Form 10-2914--600,000.

    Dated: May 28, 2004.

    By direction of the Secretary:
Loise Russell,
Director, Records Management Service.
[FR Doc. 04-12951 Filed 6-7-04; 8:45 am]
BILLING CODE 8320-01-P