[Federal Register Volume 78, Number 111 (Monday, June 10, 2013)]
[Notices]
[Pages 34709-34710]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-13693]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0219]


Proposed Information Collection (Application for CHAMPVA 
Benefits); 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 proposed revision of 
a currently approved collection, and allow 60 days for public comment 
in response to the notice. This notice solicits comments for 
information needed for Health Administration Center staff to 
adjudicate/pay healthcare benefit claims.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before August 9, 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 (10B4), Department of Veterans Affairs, 810 Vermont 
Avenue NW., Washington, DC 20420 or email: [email protected]. 
Please refer to ``OMB Control No. 2900-0219'' in any correspondence. 
During the comment period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-5870 
or Fax (202) 495-5397.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-21), 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.
    Titles:
    a. Application for CHAMPVA Benefits, VA Form 10-10d.
    b. CHAMPVA Claim Form, VA Form 10-7959a.
    c. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-
7959c.
    d. CHAMPVA Potential Liability Claim, VA Form 10-7959d.
    e. Claim for Miscellaneous Expenses, VA Form 10-7959e.
    OMB Control Number: 2900-0219.
    Type of Review: Revision of a currently approved collection.
    Abstracts:
    a. VA Form 10-10d is used to determine eligibility of persons 
applying for healthcare benefits under the CHAMPVA program.
    b. VA Form 10-7959a is used to adjudicate claims for CHAMPVA 
benefits in accordance with 30 U.S.C. Sections 501 and 1781, and 10 
U.S.C. Sections 1079 and 1086.
    c. VA Form 10-7959c is used to systematically obtain other health 
insurance information and to correctly coordinate benefits among all 
liable parties.
    d. VA Form 10-7959d form provides basic information from which 
potential liability can be assessed.
    e. Beneficiaries complete VA Form 10-7959e to carry out health care 
programs for certain children of Korea and/or Vietnam Veterans 
authorized under 38, U.S.C., chapter 18, as amended by section 401, 
Public Law 106-419 and section 102, Public Law 108-183.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-10d--5,294 hours.
    b. VA Form 10-7959a--22,402 hours.
    c. VA Form 10-7959c--6,728 hours.
    d. VA Form 10-7959d--467 hours.
    e. VA Form 10-7959e--1500 hours.

[[Page 34710]]

    Estimated Average Burden per Respondent:
    a. VA Form 10-10d--12 minutes.
    b. VA Form 10-7959a--6 minutes.
    c. VA Form 10-7959c--5 minutes.
    d. VA Form 10-7959d--7 minutes.
    e. VA Form 10-7959e--30 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. VA Form 10-10d--26,468.
    b. VA Form 10-7959a--224,018.
    c. VA Form 10-7959c--80,733.
    d. VA Form 10-7959d--4,000.
    e. VA Form 10-7959e--3,000.

    Dated: June 5, 2013.

    By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, Enterprise Records Service, Office of Information 
Security, Office of Information and Technology, U.S. Department of 
Veterans Affairs.
[FR Doc. 2013-13693 Filed 6-7-13; 8:45 am]
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