[Federal Register Volume 78, Number 21 (Thursday, January 31, 2013)]
[Notices]
[Pages 6851-6852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-02028]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0335]


Agency Information Collection (Dental Record Authorization and 
Invoice for Outpatient Services) Activity Under OMB Review

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 Veterans Health 
Administration (VHA), Department of Veterans Affairs, has submitted the 
collection of information abstracted below to the Office of Management 
and Budget (OMB) for review and comment. The PRA submission describes 
the nature of the information collection and its expected cost and 
burden and includes the actual data collection instrument.

DATES: Comments must be submitted on or before March 4, 2013.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov; or to VA's OMB Desk Officer, OMB Human 
Resources and Housing Branch, New Executive Office Building, Room 
10235, Washington, DC 20503, (202) 395-7316. Please refer to ``OMB 
Control No. 2900-0335'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492, fax (202) 632-7583 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0335.''

SUPPLEMENTARY INFORMATION: 
    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.
    An agency may not conduct or sponsor, and a person is not required 
to respond to a collection of information unless it displays a 
currently valid OMB control number. The Federal Register Notice with a 
60-day comment period

[[Page 6852]]

soliciting comments on this collection of information was published on 
November 19, 2012, on pages 69550-69551.
    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: January 25, 2013.

    By direction of the Secretary.
William F. Russo,
Deputy Director, Office of Regulations Policy and Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2013-02028 Filed 1-30-13; 8:45 am]
BILLING CODE 8320-01-P