[Federal Register Volume 79, Number 167 (Thursday, August 28, 2014)]
[Notices]
[Page 51398]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-20471]



[[Page 51398]]

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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0104]


Proposed Information Collection (Report of Accidental Injury in 
Support of Claim for Compensation or Pension/Statement of Witness to 
Accident) Activity: Comment Request

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Benefits Administration (VBA), 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 this notice. This notice solicits comments on the 
information needed to support a claim for disability benefits based on 
an accidental injury.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 27, 2014.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Nancy J. Kessinger, Veterans Benefits Administration (20M35), 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420 or email [email protected]. Please refer to ``OMB Control 
No. 2900-0104'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924 
or FAX (202) 632-8925.

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, VBA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VBA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VBA'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.
    Title: Report of Accidental Injury in Support of Claim for 
Compensation or Pension/Statement of Witness to Accident, VA Form 21P-
4176.
    OMB Control Number: 2900-0104.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA Form 21P-4176 is used to support a claim for 
disability benefits based on an accidental injury that a veteran 
incurred while in the line of duty. VA will use the data collected to 
determine whether the injury was accidental or a result of willful 
misconduct by the Veteran.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 2,200 hours.
    Estimated Average Burden Per Respondent: 30 minutes.
    Frequency of Response: One-time.
    Estimated Number of Respondents: 4,400.

    Dated: August 25, 2014.
    By direction of the Secretary.
Crystal Rennie,
Department Clearance Officer, Department of Veterans Affairs.
[FR Doc. 2014-20471 Filed 8-27-14; 8:45 am]
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