[Federal Register Volume 77, Number 39 (Tuesday, February 28, 2012)]
[Notices]
[Pages 12109-12110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-4588]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0701]


Proposed Information Collection (Bereaved Family Member 
Satisfaction Survey) Activity: Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA), 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 extension of a 
currently approved collection, and allow 60 days for public comment in 
response to the notice. This notice solicits comments for information 
to needed to assess the quality of care provided to veterans prior to 
his or her death.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before April 30, 2012.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System

[[Page 12110]]

(FDMS) at www.Regulations.gov; or to Mary Stout, Veterans Health 
Administration (193E1), Department of Veterans Affairs, 810 Vermont 
Avenue NW., Washington, DC 20420; or email: [email protected]. Please refer to ``OMB Control No. 2900-0701'' in any 
correspondence. During the comment period, comments may be viewed 
online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461-5870 or 
FAX (202) 273-9381.

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: Bereaved Family Member Satisfaction Survey, VA Form 10-
21081(NR).
    OMB Control Number: 2900-0701.
    Type of Review: Extension of a currently approved collection.
    Abstract: The data collected on VA Form 10-21081(NR) will be used 
to survey family members of deceased veterans on their satisfaction 
with the quality care provided to their loved one prior to his or her 
death at a VA facility.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 1,833 hours.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: One-time.
    Estimated Number of Respondents: 11,000.

    Dated: February 22, 2012.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012-4588 Filed 2-27-12; 8:45 am]
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