[Federal Register Volume 70, Number 205 (Tuesday, October 25, 2005)]
[Notices]
[Page 61695]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E5-5869]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0104]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Benefits Administration (VBA), Department of 
Veterans Affairs (VA), 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 the 
information needed to support a claim for disability benefits based on 
an accidental injury.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before December 27, 2005.

ADDRESSES: Submit written comments on the collection of information to 
Nancy J. Kessinger, Veterans Benefits Administration (20M35), 
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 
20420 or e-mail: [email protected]. Please refer to ``OMB Control No. 
2900-0104'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 273-7079 
or FAX (202) 275-5947.

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, VBA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VBA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VBA'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: Report of Accidental Injury in Support of Claim for 
Compensation or Pension, VA Form 21-4176.
    OMB Control Number: 2900-0104.
    Type of Review: Extension of a currently approved collection.
    Abstract: The data collected on VA Form 21-4176 is used to 
determine a veteran's eligibility for disability benefits based on an 
accidental injury that he or she incurred while in the line of duty. VA 
uses the information collected to determine whether the injury was the 
result of a willful misconduct by the veteran.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,204.
    Estimated Average Burden Per Respondent: 30 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 4,408.

    Dated: October 12, 2005.
    By direction of the Secretary.
Denise McLamb,
Program Analyst, Records Management Service.
 [FR Doc. E5-5869 Filed 10-24-05; 8:45 am]
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