[Federal Register Volume 76, Number 56 (Wednesday, March 23, 2011)]
[Notices]
[Pages 16478-16479]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-6759]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900--New (DBQs--Group 2)]


Proposed Information Collection (Disability Benefits 
Questionnaires--Group 2) Activity: 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 new 
collection and allow 60 days for public comment in response to the 
notice. This notice solicits comments for information needed to obtain 
medical evidence to adjudicate a claim for disability benefits.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before May 23, 2011.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits 
Administration (20M33), Department of Veterans Affairs, 810 Vermont 
Avenue, NW., Washington, DC 20420 or e-mail to [email protected]. 
Please refer to ``OMB Control No. 2900--New (DBQs--Group 2)'' in any 
correspondence. During the comment period, comments may be viewed 
online through FDMS.

FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 461-9769 
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.

[[Page 16479]]

Titles

    a. Arteries and Veins Conditions (Vascular Diseases including 
Varicose Veins) Disability Benefits Questionnaire, VA Form 21-0960A-2.
    b. Hypertension Disability Benefits Questionnaire, VA Form 21-
0960A-3.
    c. Non-ischemic Heart Disease (including Arrhythmias and Surgery) 
Disability Benefits Questionnaire, VA Form 21-0960A-4.
    d. Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor 
Peripheral Neuropathy) Disability Benefits Questionnaire, VA Form 21-
0960C-4.
    e. Diabetes Mellitus Disability Benefits Questionnaire, VA Form 21-
0960E-1.
    f. Scar/Disfigurement Disability Benefits Questionnaire, VA Form 
21-0960F-1.
    g. Skin Diseases Disability Benefits Questionnaire, VA Form 21-
0960F-2.
    h. Amputations Disability Benefits Questionnaire, VA Form 21-0960M-
1.
    i. Ankle Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-2.
    j. Elbow and Forearm Conditions Disability Benefits Questionnaire, 
VA Form 21-0960M-4.
    k. Flatfoot (PES PLANUS) Disability Benefits Questionnaire, VA Form 
21-0960M-5.
    l. Foot Miscellaneous (other than flatfoot/PES PLANUS), Disability 
Benefits Questionnaire, VA Form 21-0960M-6.
    m. Hand and Finger Conditions Disability Benefits Questionnaire, VA 
Form 21-0960M-7.
    n. Hip and Thigh Conditions Disability Benefits Questionnaire, VA 
Form 21-0960M-8.
    o. Knee and Lower Leg Conditions Disability Benefits Questionnaire, 
VA Form 21-0960M-9.
    p. Muscle Injuries Disability Benefits Questionnaire, VA Form 21-
0960M-10.
    q. Shoulder and Arm Conditions Disability Benefits Questionnaire, 
VA Form 21-0960M-12.
    r. Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire, VA Form 21-0960M-15.
    s. Wrist Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-16.
    t. Eye Conditions Disability Benefits Questionnaire, VA Form 21-
0960N-2.
    OMB Control Number: 2900--New (DBQs--Group 2).
    Type of Review: New collection.
    Abstract: Data collected on VA Form 21-0960 series will be used to 
obtain information from claimants treating physician that is necessary 
to adjudicate a claim for disability benefits.
    Affected Public: Individuals or households.

Estimated Annual Burden

    a. VA Form 21-0960A-2--10,000.
    b. VA Form 21-0960A-3--12,500.
    c. VA Form 21-0960A-4--10,000.
    d. VA Form 21-0960C-4--37,500.
    e. VA Form 21-0960E-1--18,750.
    f. VA Form 21-0960F-1--6,250.
    g. VA Form 21-0960F-2--6,250.
    h. VA Form 21-0960M-1--12,500.
    i. VA Form 21-0960M-2--15,000.
    j. VA Form 21-0960M-4--10,000.
    k. VA Form 21-0960M-5--12,500.
    l. VA Form 21-0960M-6--7,500.
    m. VA Form 21-0960M-7--15,000.
    n. VA Form 21-0960M-8--25,000.
    o. VA Form 21-0960M-9--25,000.
    p. VA Form 21-0960M-10--15,000.
    q. VA Form 21-0960M-12--25,000.
    r. VA Form 21-0960M-15--3,750.
    s. VA Form 21-0960M-16--20,000.
    t. VA Form 21-0960N-2--30,000.

Estimated Average Burden per Respondent

    a. VA Form 21-0960A-2--30 minutes.
    b. VA Form 21-0960A-3--15 minutes.
    c. VA Form 21-0960A-4--30 minutes.
    d. VA Form 21-0960C-4--30 minutes.
    e. VA Form 21-0960E-1--15 minutes.
    f. VA Form 21-0960F-1--15 minutes.
    g. VA Form 21-0960F-2--15 minutes.
    h. VA Form 21-0960M-1--30 minutes.
    i. VA Form 21-0960M-2--30 minutes.
    j. VA Form 21-0960M-4--30 minutes.
    k. VA Form 21-0960M-5--15 minutes.
    l. VA Form 21-0960M-6--15 minutes.
    m. VA Form 21-0960M-7--30 minutes.
    n. VA Form 21-0960M-8--30 minutes.
    o. VA Form 21-0960M-9--30 minutes.
    p. VA Form 21-0960M-10--30 minutes.
    q. VA Form 21-0960M-12--30 minutes.
    r. VA Form 21-0960M-15--15 minutes.
    s. VA Form 21-0960M-16--30 minutes.
    t. VA Form 21-0960N-2--45 minutes.
    Frequency of Response: On occasion.

Estimated Number of Respondents

    a. VA Form 21-0960A-2--20,000.
    b. VA Form 21-0960A-3--50,000.
    c. VA Form 21-0960A-4--20,000.
    d. VA Form 21-0960C-4--75,000.
    e. VA Form 21-0960E-1--75,000.
    f. VA Form 21-0960F-1--25,000.
    g. VA Form 21-0960F-2--25,000.
    h. VA Form 21-0960M-1--25,000.
    i. VA Form 21-0960M-2--30,000.
    j. VA Form 21-0960M-4--20,000.
    k. VA Form 21-0960M-5--50,000.
    l. VA Form 21-0960M-6--30,000.
    m. VA Form 21-0960M-7--30,000.
    n. VA Form 21-0960M-8--50,000.
    o. VA Form 21-0960M-9--50,000.
    p. VA Form 21-0960M-10--30,000.
    q. VA Form 21-0960M-12--50,000.
    r. VA Form 21-0960M-15--15,000.
    s. VA Form 21-0960M-16--40,000.
    t. VA Form 21-0960N-2--40,000.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-6759 Filed 3-22-11; 8:45 am]
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