[Federal Register Volume 76, Number 96 (Wednesday, May 18, 2011)]
[Notices]
[Pages 28851-28852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-12137]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0629]


Proposed Information Collection (Application for Extended Care 
Services); 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 
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 July 18, 2011.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at http://www.Regulations.gov; or to Cynthia Harvey-Pryor, 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. During the comment period, comments may be viewed 
online through FDMS.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461-5870 or 
FAX (202) 273-9387.

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, 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 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.
    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.


[[Page 28852]]


    Dated: May 12, 2011.

    By direction of the Secretary:
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-12137 Filed 5-17-11; 8:45 am]
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