[Federal Register Volume 76, Number 118 (Monday, June 20, 2011)]
[Notices]
[Pages 35950-35951]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-15202]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New (DBQs--Group 3)]


Agency Information Collection (Disability Benefits 
Questionnaires--Group 3) Activity Under OMB Review

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits 
Administration (VBA), Department of Veterans Affairs, will submit 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; it includes the actual data collection instrument.

DATES: Comments must be submitted on or before July 20, 2011.

ADDRESSES: Submit written comments on the collection of information 
through http://www.Regulations.gov or 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-New (DBQs--Group 3)'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Washington, DC 20420, (202) 461-7485, FAX (202) 461-0966 or e-mail 
[email protected]. Please refer to ``OMB Control No. 2900--New 
(DBQs--Group 3).''

SUPPLEMENTARY INFORMATION: 
    Titles:
    a. Central Nervous System and Neuromusculo Diseases, Disability 
Benefits Questionnaire, VA Form 21-0960C-5.
    b. Headaches (Including Migraine Headaches), Disability Benefits 
Questionnaire, VA Form 21-0960C-8.
    c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA 
Form 21-0960C-9.
    d. Esophageal Disorders (Including GERD), Disability Benefits 
Questionnaire, VA Form 21-0960G-1.
    e. Gallbladder and Pancreas Conditions, Disability Benefits 
Questionnaire, VA Form 21-0960G-2.
    f. Intestinal Disorders (Other Than Surgical or Infectious) 
(Including

[[Page 35951]]

Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and 
Diverticulitis) Disability Benefits Questionnaire, VA Form 21-0960G-3.
    g. Intestines Surgical and/or Infectious Intestinal Disorders 
(Bowel Resection, Colostomy, Ileostomy, Bacterial and Parasitic 
Infections) Disability Benefits Questionnaire, VA Form 21-0960G-4.
    h. Hepatitis, Cirrhosis and Other Liver Conditions, Disability 
Benefits Questionnaire, VA Form 21-0960G-5.
    i. Peritoneal Adhesions Disability Benefits Questionnaire, VA Form 
21-0960G-6.
    j. Stomach and Duodenal Conditions (Not Including GERD or 
Esophageal Disorders) Disability Benefits Questionnaire, VA Form 21-
0960G-7.
    k. Rectum and Anus Disability Benefits Questionnaire, VA Form 21-
0960H-2.
    l. Breast Conditions and Disorders Disability Benefits 
Questionnaire, VA Form 21-0960K-1.
    m. Gynecological Conditions Disability Benefits Questionnaire, VA 
Form 21-0960K-2.
    n. Sleep Apnea Disability Benefits Questionnaire, VA Form 21-0960L-
2.
    o. Arthritis Disability Benefits Questionnaire, VA Form 21-0960M-3.
    p. Osteomyelitis Disability Benefits Questionnaire, VA Form 21-
0960M-11.
    q. Ear Conditions (Including Vestibular and Infectious) Disability 
Benefits Questionnaire, VA Form 21-0960N-1.
    OMB Control Number: 2900-New (DBQs--Group 3).
    Type of Review: New collection.
    Abstract: Data collected on VA Form 21-0960 series will be used 
obtain information from claimants treating physician that is necessary 
to adjudicate a claim for disability benefits.
    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 April 15, 2011, at pages 21429-21430.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 21-0960C-5--5,000.
    b. VA Form 21-0960C-8--3,750.
    c. VA Form 21-0960C-9--7,500.
    d. VA Form 21-0960G-1--10,000.
    e. VA Form 21-0960G-2--1,250.
    f. VA Form 21-0960G-3--1,250.
    g. VA Form 21-0960G-4--1,250.
    h. VA Form 21-0960G-5--5,000.
    i. VA Form 21-0960G-6--1,250.
    j. VA Form 21-0960G-7--2,500.
    k. VA Form 21-0960H-2--2,500.
    l. VA Form 21-0960K-1--7,500.
    m. VA Form 21-0960K-2--10,000.
    n. VA Form 21-0960L-2--1,250.
    o. VA Form 21-0960M-3--25,000.
    p. VA Form 21-0960M-11--10,000.
    q. VA Form 21-0960N-1--6,250.
    Estimated Average Burden per Respondent:
    a. VA Form 21-0960C-5--30 minutes.
    b. VA Form 21-0960C-8--15 minutes.
    c. VA Form 21-0960C-9--45 minutes.
    d. VA Form 21-0960G-1--15 minutes.
    e. VA Form 21-0960G-2--15 minutes.
    f. VA Form 21-0960G-3--15 minutes.
    g. VA Form 21-0960G-4--15 minutes.
    h. VA Form 21-0960G-5--30 minutes.
    i. VA Form 21-0960G-6--15 minutes.
    j. VA Form 21-0960G-7--15 minutes.
    k. VA Form 21-0960H-2--15 minutes.
    l. VA Form 21-0960K-1--15 minutes.
    m. VA Form 21-0960K-2--30 minutes.
    n. VA Form 21-0960L-2--15 minutes.
    o. VA Form 21-0960M-3--15 minutes.
    p. VA Form 21-0960M-11--15 minutes.
    q. VA Form 21-0960N-1--15 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. VA Form 21-0960C-5--10,000.
    b. VA Form 21-0960C-8--15,000.
    c. VA Form 21-0960C-9--10,000.
    d. VA Form 21-0960G-1--40,000.
    e. VA Form 21-0960G-2--5,000.
    f. VA Form 21-0960G-3--5,000.
    g. VA Form 21-0960G-4--5,000.
    h. VA Form 21-0960G-5--10,000.
    i. VA Form 21-0960G-6--5,000.
    j. VA Form 21-0960G-7--10,000.
    k. VA Form 21-0960H-2--10,000.
    l. VA Form 21-0960K-1--30,000.
    m. VA Form 21-0960K-2--20,000.
    n. VA Form 21-0960L2--5,000.
    o. VA Form 21-0960M-3--100,000.
    p. VA Form 21-0960M-11--40,000.
    q. VA Form 21-0960N-1--25,000.

    By direction of the Secretary.

    Dated: June 15, 2011.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-15202 Filed 6-17-11; 8:45 am]
BILLING CODE 8320-01-P