[Federal Register Volume 69, Number 230 (Wednesday, December 1, 2004)]
[Notices]
[Page 69993]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-26466]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New]


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 new collection, and allow 60 days for public comment in response 
to the notice. This notice solicits comments on information needed to 
file a civil rights discrimination complaint.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before January 31, 2005.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (193E1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail [email protected]. Please refer to ``OMB Control No. 2900-
New'' 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: Civil Rights Discrimination Complaint, VA Form 10-0381.
    OMB Control Number: 2900-New.
    Type of Review: New collection.
    Abstract: VA Form 10-0381 is completed by veterans and other VHA 
customers who believe their civil rights were discriminated by agency 
employees while receiving medical care or services in VA medical 
centers, or institutions such as state homes receiving federal 
financial assistance from VA to file a formal complaint of the alleged 
discrimination.
    Affected Public: Individuals or households.
    Estimated Total Annual Burden: 46 hours.
    Estimated Average Burden Per Respondent: 15 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 183.

    Dated: November 22, 2004.

    By direction of the Secretary.
Loise Russell,
Director, Records Management Service.
[FR Doc. 04-26466 Filed 11-30-04; 8:45 am]
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