[Federal Register Volume 77, Number 223 (Monday, November 19, 2012)]
[Notices]
[Pages 69550-69551]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-28030]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0335]


Proposed Information Collection (Dental Record Authorization and 
Invoice for Outpatient Services) Activity: 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 on the information needed to determine a veteran's 
dental treatment needs, and the fees associated for these services.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before January 18, 2013.

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 email: [email protected]. 
Please refer to ``2900-0335'' 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

[[Page 69551]]

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: Dental Record Authorization and Invoice for Outpatient 
Services, VA Form 10-2570d.
    OMB Control Number: 2900-0335.
    Type of Review: Extension of a currently approved collection.
    Abstract: VA Form 10-2570d is essential to the proper 
administration of VA outpatient fee dental program. The associated 
instructions make it possible to communicate with clarity the required 
procedures, peculiarities, and precautions associated with VA 
authorizations for contracting with private dentists for the provision 
of dental treatment for eligible veteran beneficiaries. Since most of 
the veterans who are authorized fee dental care are geographically 
inaccessible to VA dental clinics, it is necessary to request 
information as to the veteran's oral condition, treatment needs and the 
usual customary fees for these services from the private fee dentist 
whom the veteran has selected. The form lists the dental treatment 
needs of the veteran patient, the cost to VA to provide such services, 
and serves as an invoice for payment. VA uses the data collected to 
verify the veteran's eligibility to receive dental benefits.
    Affected Public: Business and other for profit.
    Estimated Total Annual Burden: 3,666 hours.
    Estimated Average Burden per Respondent: 20 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 11,000.

    Dated: November 14, 2012.

    By direction of the Secretary.

Robert C. McFetridge,
Director, Office of Regulations Policy and Management, Office of the 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2012-28030 Filed 11-16-12; 8:45 am]
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