[Federal Register Volume 70, Number 90 (Wednesday, May 11, 2005)]
[Notices]
[Pages 24864-24865]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E5-2304]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0629]


Agency Information Collection Activities Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-21), this notice announces that the Veterans Health 
Administration (VHA), Department of Veterans Affairs, has submitted the 
collection of information abstracted below to the Office of Management 
and Budget (OMB) for review and comment. The PRA submission describes 
the nature of the information collection and its expected cost and 
burden and includes the actual data collection instrument.

[[Page 24865]]


DATES: Comments must be submitted on or before June 10, 2005.

FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT: Denise 
McLamb, Records Management Service (005E3), Department of Veterans 
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273-8030, 
fax (202) 273-5981 or e-mail to: [email protected]. Please 
refer to ``OMB Control No. 2900-0629.''
    Send comments and recommendations concerning any aspect of the 
information collection to VA's OMB Desk Officer, OMB Human Resources 
and Housing Branch, New Executive Office Building, Room 10235, 
Washington, DC 20503, (202) 395-7316. Please refer to ``OMB Control No. 
2900-0629'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    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 when applying for extended care services and to establish a co-
payment agreement for such services. VA provides extended care to non-
service connected veterans who are unable to defray the necessary 
expenses of care if their income is not greater than the maximum annual 
pension rate. VA uses the data collected to establish the veteran's 
eligibility for extended care services, financial liability, if any, of 
the veteran to pay if accepted for placement or treatment in extended 
care services, and to determine the appropriate co-payment.
    An agency may not conduct or sponsor, and a person is not required 
to respond to a collection of information unless it displays a 
currently valid OMB control number. The Federal Register notice with a 
60-day comment period soliciting comments on this collection of 
information was published on January 5, 2005, at pages 939-940.
    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: April 29, 2005.

    By direction of the Secretary.
Loise Russell,
Director, Records Management Service.
[FR Doc. E5-2304 Filed 5-10-05; 8:45 am]
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