[Federal Register Volume 77, Number 166 (Monday, August 27, 2012)]
[Notices]
[Pages 51849-51850]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-20916]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-New (VA Form 10-0529a-f)]


Agency Information Collection: Emergency Submission for OMB 
Review (PACT Demo Lab, Clinical Innovation Study: Implementation of a 
Patient Centered Medical Home for OEF/OIF Veterans With PTSD: Bridging 
Primary and Behavioral Health Care); 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 develop and evaluate a patient-centered model of 
care for OEF/OIF veterans with PTSD.

DATES: Comments must be submitted on or before September 6, 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 10-0529a-f).

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 (10-0529a-f).

SUPPLEMENTARY INFORMATION:
    Titles: PACT Demo Lab, Clinical Innovation Study: Implementation of 
a Patient Centered Medical Home for

[[Page 51850]]

OEF/OIF Veterans with PTSD: Bridging Primary and Behavioral Health 
Care.
    a. SF 12, Questionnaire, VA Form 10-0529.
    b. (Patient Health Questionnaire-9 (PHQ-9), VA Form 10-0529a.
    c. PTSD Checklist (PCL), VA Form 10-0529Bb.
    d. Patient Satisfaction Questionnaire- Short Form (PSQ-18), VA Form 
10-0529c.
    e. Combat Exposure Scale (CES), VA Form 10-0529d.
    f. World Health Organization Quality of Life (WHOQOL-BREF), VA Form 
10-0529e.
    g. World Health Organization Disability Assessment Schedule II 
(WHODAS-II), VA Form 10-0529f.
    OMB Control Number: 2900-New.
    Type of Review: New data collection.
    The data collected on VA Forms 10-0529a-f will be used to develop 
and evaluate a patient-centered model of care for OEF/OIF Veterans with 
PTSD. The forms will be used to survey the effectiveness of the patient 
centered medical home model by enhancing the conventional care 
currently provided in the care of patients with PTSD.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 420.
    Frequency of Response: Annually.
    Estimated Average Burden per Respondent: 10 minutes.
    Estimated Number of Respondents: 840.
    Estimated Number of Responses: 2,520.

    Dated: August 21, 2012.

    By direction of the Secretary.
Denise McLamb,
Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20916 Filed 8-24-12; 8:45 am]
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