[Federal Register Volume 79, Number 128 (Thursday, July 3, 2014)]
[Notices]
[Pages 38127-38128]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-15550]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0188]


Agency Information Collection (Claims, Authorization, and Invoice 
for Prosthetic Items and Services) Activities 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, will submit 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: Written comments and recommendations on the proposed collection 
of information should be received on or before August 4, 2014.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
[email protected]. Please refer to ``OMB Control No. 2900-
0188 (Claims, Authorization, and Invoice for Prosthetic items and 
Services)'' in any correspondence. During the comment period, comments 
may be viewed online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
[email protected]. Please refer to ``OMB Control No. 2900-NEW 
(Veterans, Researchers, and IRB Members Experiences with Recruitment 
Restrictions)'' in any correspondence.

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

[[Page 38128]]

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.

SUPPLEMENTARY INFORMATION: 
    Titles:
    1. Veterans Application for Assistance in Acquiring Home 
Improvement and Structural Alterations, VA Form 10-0103.
    2. Application for Adaptive Equipment for Motor Vehicle, VA Form 
10-1394.
    3. Prosthetic Authorization for Items or Services, VA Form 10-2421.
    4. Request to Submit Quotation, VA Form Fl-10-90.
    5. Prescription Authorization for Glasses, VA Form 10-2914.
    6. Prosthetic Service Card Invoice, VA Form 10-2520.
    Type of Review: Revision of a currently approved collection.
    Abstracts:
    a. VA Form 10-0103, Veterans Application for Assistance in 
Acquiring Home Improvement and Structural Alterations (HISA) grants, is 
used by the Prosthetic Service to determine eligibility/entitlement and 
reimbursement of individual claims for home improvement and structural 
alterations.
    b. VA Form 10-1394, Application for Adaptive Equipment Motor 
Vehicle. This form is used by VHA Prosthetic Service, Fiscal Service 
and Veterans Benefits Administration to determine eligibility/
entitlement and reimbursement of individual claims for automotive 
adaptive equipment.
    c. VA Form 10-2421, Prosthetic Authorization for Items or Services, 
is used for the direct procurement of new prosthetic appliances and/or 
services by PSAS (Prosthetic and Sensory Aids Service) under the COCP 
(Contracting Officers Certification Program). Warrants to PSAS 
personnel are authorized for open market and Federal Supply Schedule 
purchases, and decentralized and local beneficiary service contracts.
    d. VA Form 10-2520, Prosthetic Service Card Invoice, is used by the 
vendor as an invoice and billing document.
    e. VA Form 10-2914, Prescription and Authorization for Fee Basis 
Eyeglasses, is used as a combination prescription, authorization and 
invoice. It purchases eyeglasses directly for veterans.
    f. Form Letter 10-90, Request to Submit Quotation, is used by the 
VAMC Prosthetics Service to request a quotation for items listed.
    g. Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-0103- 583 hours.
    b. VA Form 10-01394--1,000 hours.
    c. VA Form 10-2421--67 hours.
    d. VA Form 10-2520--47 hours.
    e. VA Form 10-2914--3,333 hours.
    f. VA Form Letter 10-90--708 hours.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-0103--5 minutes.
    b. VA Form 10-1394 -15 minutes
    c. VA Form 10-2421--4 minutes.
    d. VA Form 10-2520--4 minutes.
    e. VA Form 10-2914--4 minutes.
    f. VA Form Letter 10-90--5 minutes.
    Frequency of Response: Annually.
    Estimated Annual Responses:
    a. VA Form 10-0103--7,000.
    b. VA Form 10-1394--4,000.
    c. VA Form 10-2421--1,000.
    d. VA Form 10-2520--700.
    e. VA Form 10-2914--50,000.
    f. VA Form Letter 10-90--8,500.

    Dated: June 27, 2014.

    By direction of the Secretary.

Crystal Rennie,
VA Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2014-15550 Filed 7-2-14; 8:45 am]
BILLING CODE 8320-01-P