[Federal Register Volume 76, Number 197 (Wednesday, October 12, 2011)]
[Notices]
[Page 63353]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-26286]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0620]


Proposed Information Collection (Payment and Reimbursement for 
Emergency Services for Non Service-Connected Conditions in Non-VA 
Facilities); 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 for information needed to determine a claimant's 
eligibility for reimbursement or payment for emergency medical 
treatment at a non-VA facility.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before December 12, 2011.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to Cynthia Harvey-Pryor, Veterans Health 
Administration (10P7BFP), Department of Veterans Affairs, 810 Vermont 
Avenue, NW., Washington, DC 20420 or e-mail: cynthia.harvey-
[email protected]. Please refer to ``OMB Control No. 2900-0620'' 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: Payment and Reimbursement for Emergency Services for Non 
Service-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725.
    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 furnished to the veteran must 
submit a claim in writing or complete a Health Insurance Claim Form CMS 
1500 or Medical Uniform Institutional Provider Bill Form UB-04 to 
request payment or reimbursement for such treatment. VA uses the data 
collected to determine the claimant's eligibility for payment or 
reimbursement.
    Affected Public: Business or other for-profit.
    Estimated Total Annual Burden: 82,690 hours.
    Estimated Average Burden Per Respondent: 15 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 330,759.

    Dated: October 6, 2011.

    By direction of the Secretary:
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-26286 Filed 10-11-11; 8:45 am]
BILLING CODE 8320-01-P