[Federal Register Volume 77, Number 162 (Tuesday, August 21, 2012)]
[Notices]
[Pages 50547-50548]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-20457]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900--New VA Form (VA Form 10-0532a-k)]


Agency Information Collection: Emergency Submission for OMB 
Review (PACT: Clinical Innovation Study--Helping Veterans Manage 
Chronic Pain); Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C., 3501-3521), this notice announces that the Department of 
Veterans Affairs (VA), will submit to the Office of Management and 
Budget (OMB) the following emergency proposal for the collection of 
information under the provisions of the Paperwork Reduction Act (44 
U.S.C. 3507(j)(1)). An emergency clearance is being requested for 
information needed to assess the effectiveness of pain care management 
provided to veterans.

DATES: Comments must be submitted on or before August 31, 2012.

ADDRESSES: Send comments and recommendations concerning any aspect of 
the information collection to VA's OMB Desk Officer, OMB Human 
Resources and Housing Branch, New Executive Office Building, Room 
10235, Washington, DC 20503, (202) 395-7316 or Fax (202) 395-6974. 
Please refer to ``2900--New VA Form (VA Form 10-0532a-k).

FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7479, Fax (202) 632-7583 or email: 
[email protected]. Please refer to ``OMB Control No. 2900--New VA 
Form (VA Form 10-0532a-k).''

SUPPLEMENTARY INFORMATION: 
    Titles: Clinical Innovation Study--Helping Veterans Manage Chronic 
Pain.
    a. Pain Care Management Tracking Tool, VA Form 10-0532.
    b. Pain Care Management Self Monitoring Form (unpublished), VA Form 
10-0532a.
    c. Pain Outcomes Questionnaire (Clark, Gironda, & Young, 2003), VA 
Form 10-0532b.
    d. The Multidimensional Pain Inventory (MPI; Kearns, Turk, & Rudy, 
1985), VA Form 10-0532c.
    e. Pain Catastrophizing Scale (Osman, Barrios, Gutierrez, Kopper, 
Merrifield, & Grittmann, 2000), VA Form 10-0532d.
    f. The Oswestry Disability Index (Fairbank & Pynsent, 2000), VA 
Form 10-0532e.
    g. Brief Pain Inventory--Short Form (BPI; Cleeland, 1991). 
Administered at baseline and each follow-up, VA Form 10-0532f.
    h. Fear-Avoidance Beliefs Questionnaire (FABQ; Waddell, Newton, et 
al., 1993), VA Form 10-0532g.
    i. The Brief COPE (Carver, 1997), VA Form 10-0532h.
    j. Depression and Anxiety Stress Scales (DASS-21; Lovibond & 
Lovibond, 1995), VA Form 10-0532i.
    k. Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & 
Williams, 2001), VA Form 10-0532j.
    l. Generalized Anxiety Disorder (GAD-7); Spitzer, Kroenke, 
Williams, & Lowe, 2006), VA Form 10-0532k.
    OMB Control Number: 2900-New.
    Type of Review: New data collection.
    Abstract: The data collected on VA Forms VA Form 10-0532a-k will be 
used to: (1) Assess the effectiveness of patient care management (PCM) 
in increasing patients' functionality, improving quality of life, and 
improving paint control relative to usual care and (2) to assess the 
impact of PCM on depression and anxiety relative to usual care. This 
data collection's model has been designed to serve patients by 
augmenting existing pain management interventions (e.g., medications, 
physical therapy) by teaching pain care management skills that patients 
can incorporate into their daily activities. VA will use the 
information to evaluate the effectiveness of the intervention so that 
it can most effectively be applied to future patients with chronic pain 
problems.

[[Page 50548]]

    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-0532--67 hours.
    b. VA Form 10-0532a--80 hours.
    c. VA Form 10-0532b--200 hours.
    d. VA Form 10-0532c--80 hours.
    e. VA Form 10-0532d--53 hours.
    f. VA Form 10-0532e--53 hours.
    g. VA Form 10-0532f--133 hours.
    h. VA Form 10-0532g--19 hours.
    i. VA Form 10-0532h--27 hours.
    j. VA Form 10-0532i--93 hours.
    k. VA Form 10-0532j- 67 hours.
    l. VA Form 10-0532k--67 hours.
    Estimated Average Burden per Respondent:
    a. VA Form 10-0532--5 minutes.
    b. VA Form 10-0532a--10 minutes.
    c. VA Form 10-0532b--15 minutes.
    d. VA Form 10-0532c--15 minutes.
    e. VA Form 10-0532d--10 minutes.
    f. VA Form 10-0532e--10 minutes.
    g. VA Form 10-0532f--10 minutes.
    h. VA Form 10-0532g--7 minutes.
    i. VA Form 10-0532h--10 minutes.
    j. VA Form 10-0532i--7 minutes.
    k. VA Form 10-0532j--5 minutes.
    l. VA Form 10-0532k--5 minutes,
    Frequency of Response: Monthly.
    Estimated Number of Respondents:
    a. VA Form 10-0532--800.
    b. VA Form 10-0532a--480.
    c. VA Form 10-0532b--800.
    d. VA Form 10-0532c--320.
    e. VA Form 10-0532d--320.
    f. VA Form 10-0532e--320.
    g. VA Form 10-0532f--800.
    h. VA Form 10-0532g--160.
    i. VA Form 10-0532h--160.
    j. VA Form 10-0532i--800.
    k. VA Form 10-0532j--800.
    l. VA Form 10-0532k--800

    Dated: August 16, 2012.

    By direction of the Secretary.

Denise McLamb,
Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20457 Filed 8-20-12; 8:45 am]
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