[Federal Register Volume 70, Number 202 (Thursday, October 20, 2005)]
[Notices]
[Page 61173]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E5-5780]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0620]


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.

DATE: Comments must be submitted on or before November 21, 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) 565-8374, 
FAX (202) 565-6950 or e-mail to: [email protected]. Please 
refer to ``OMB Control No. 2900-0620.''
    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. 
2900-0620'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Title: Payment and Reimbursement for Emergency Services for Non 
Service-Connected Conditions in Non-VA Facilities.
    OMB Control Number: 2900-0620.
    Type of Review: Extension of a currently approved collection.
    Abstract: Veterans enrolled in VA's health-care system are 
personally liable for emergency treatment rendered at non-VA health 
facilities. Veterans or their representative, and the health care 
provider of the emergency treatment to the veteran must submit a claim 
in writing or complete a Health Insurance Claim Form HCFA 1450 and 1500 
or Medical Uniform Institutional Provider Bill Form UB-82 and 92 to 
request payment or reimbursement for such treatment. VA uses the data 
collected to determine the claimant's eligibility for payment or 
reimbursement.
    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 June 22, 2005, at page 36234.
    Affected Public: Business or other for-profit, individuals or 
households, and not-for-profit institutions.
    Estimated Total Annual Burden: 147,187 hours.
    Estimated Average Burden Per Respondent: 30 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 294,373.

    Dated: October 6, 2005.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Records Management Service,
[FR Doc. E5-5780 Filed 10-19-05; 8:45 am]
BILLING CODE 8320-01-P