[Federal Register Volume 70, Number 3 (Wednesday, January 5, 2005)]
[Notices]
[Pages 939-940]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-204]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0629]


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

[[Page 940]]

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 for 
extended care benefits.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before March 7, 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-
0629'' 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.
    Title: Application for Extended Care Services, VA Form 10-10EC.
    OMB Control Number: 2900-0629.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 10-10EC is used to gather current income and 
financial information from nonservice-connected veterans and their 
spouse applying for extended care services. VA uses the data collected 
to establish veteran's eligibility for extended care services, 
financial liability, if any, to pay if accepted for placement or 
treatment in extended care services, and the applicable co-payment.
    Affected Public: Individuals or Households.
    Estimated Total Annual Burden: 9,000 hours.
    Estimated Average Burden Per Respondent: 90 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 6,000.

    Dated: December 22, 2004.

    By direction of the Secretary:
Jacqueline Parks,
IT Specialist, Records Management Service.
[FR Doc. 05-204 Filed 1-4-05; 8:45 am]
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