[Federal Register Volume 79, Number 243 (Thursday, December 18, 2014)]
[Notices]
[Pages 75618-75619]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-29630]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0781]


Agency Information Collection (Disability Benefits 
Questionnaires--Group 4) Activity Under OMB Review

AGENCY: Veterans Benefits 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 Benefits 
Administration (VBA), 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; it includes the actual data collection instrument.

DATES: Comments must be submitted on or before January 20, 2015.

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-
0781'' 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. 2900-0781.''

SUPPLEMENTARY INFORMATION:

Titles

    (a) Cranial Nerve Conditions Disability Benefits Questionnaire, VA 
Form 21-0960-C-3.
    (b) Narcolepsy Disability Benefits Questionnaire, VA Form 21-0960-
C-6.
    (c) Fibromyalgia Disability Benefits Questionnaire, VA Form 21-
0960-C-7.
    (d) Seizure Disorders (Epilepsy) Disability Benefits Questionnaire, 
VA Form 21-0960-C-11.
    (e) Oral and Dental Conditions Including Mouth, Lips and Tongue 
(Other than Temporomandibular Joint Conditions) Disability Benefits 
Questionnaire, VA Form 21-0960-D-1.
    (f) Endocrine Diseases (other than Thyroid, Parathyroid or Diabetes 
Mellitus) Disability Benefits Questionnaire, VA Form 21-0960-E-2.
    (g) Thyroid & Parathyroid Conditions Disability Benefits 
Questionnaire, VA Form 21-0960-E-3.
    (h) Hernias (Including Abdominal, Inguinal, and Femoral Hernias) 
Disability Benefits Questionnaire, VA Form 21-0960-H-1.
    (i) HIV-Related Illnesses Disability Benefits Questionnaire, VA 
Form 21-0960-I-2.
    (j) Infectious Diseases (other than HIV-Related Illness, Chronic 
Fatigue Syndrome, or Tuberculosis) Disability Benefits Questionnaire, 
VA Form 21-0960I-3.
    (k) Systemic Lupus Erythematosus (SLE) and Other Autoimmune 
Diseases Disability Benefits Questionnaire, VA Form 21-0960-I-4.
    (l) Nutritional Deficiencies Disability Benefits Questionnaire, VA 
Form 21-0960-I-5.
    (m) Urinary Tract (including Bladder & Urethra) Conditions 
(excluding Male Reproductive System) Disability Benefits Questionnaire, 
VA Form 21-0960-J-4.
    (n) Respiratory Conditions (other than Tuberculosis and Sleep 
Apnea)

[[Page 75619]]

Disability Benefits Questionnaire, VA Form 21-0960-L-1.
    (o) Loss of Sense of Smell and/or Taste Disability Benefits 
Questionnaire, VA Form 21-0960-N-3.
    (p) Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, 
Larynx, and Pharynx Disability Benefits Questionnaire, VA Form 21-0960-
N-4.
    (q) Chronic Fatigue Syndrome Disability Benefits Questionnaire, VA 
Form 21-0960-Q-1.
    OMB Control Number: 2900-0781.
    Type of Review: Revision
    Abstract: Data collected on VA Form 21-0960 series will be used to 
obtain information from claimant's treating physician that is necessary 
to adjudicate a claim for disability 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 soliciting comments on this collection of 
information was published on August 28, 2014, at pages 51399-51400.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 53,750 hours.

(a) VAF 21-0960-C-3--5,000
(b) VAF 21-0960-C-6--1,250
(c) VAF 21-0960-C-7--1,250
(d) VAF 21-0960-C-11--1,250
(e) VAF 21-0960-D-1--1,250
(f) VAF 21-0960-E-2--2,500
(g) VAF 21-0960-E-3--2,500
(h) VAF 21-0960-H-1--3,750
(i) VAF 21-0960-I-2--1,250
(j) VAF 21-0960-I-3--2,500
(k) VAF 21-0960-I-4--2,500
(l) VAF 21-0960-I-5--1,250
(m) VAF 21-0960-J-4--3,750
(n) VAF 21-0960-L-1--10,000
(o) VAF 21-0960-N-3--1,250
(p) VAF 21-0960-N-4--10,000
(q) VAF 21-0960-Q-1--2,500
    Estimated Average Burden Per Respondent:
(a) VAF 21-0960-C-3--30 minutes
(b) VAF 21-0960-C-6--15 minutes
(c) VAF 21-0960-C-7--15 minutes
(d) VAF 21-0960-C-11--15 minutes
(e) VAF 21-0960-D-1--15 minutes
(f) VAF 21-0960-E-2--15 minutes
(g) VAF 21-0960-E-3--15 minutes
(h) VAF 21-0960-H-1--15 minutes
(i) VAF 21-0960-I-2--15 minutes
(j) VAF 21-0960-I-3--15 minutes
(k) VAF 21-0960-I-4--30 minutes
(l) VAF 21-0960-I-5--15 minutes
(m) VAF 21-0960-J-4--15 minutes
(n) VAF 21-0960-L-1--30 minutes
(o) VAF 21-0960-N-3--15 minutes
(p) VAF 21-0960-N-4--30 minutes
(q) VAF 21-0960-Q-1--15 minutes

    Frequency of Response: On occasion.
    Estimated Number of Respondents: TOTAL: 160,000.

(a) VAF 21-0960-C-3--10,000
(b) VAF 21-0960-C-6--5,000
(c) VAF 21-0960-C-7--5,000
(d) VAF 21-0960-C-11--5,000
(e) VAF 21-0960-D-1--5,000
(f) VAF 21-0960-E-2--10,000
(g) VAF 21-0960-E-3--10,000
(h) VAF 21-0960-H-1--15,000
(i) VAF 21-0960-I-2--5,000
(j) VAF 21-0960-I-3--10,000
(k) VAF 21-0960-I-4--5,000
(l) VAF 21-0960-I-5--5,000
(m) VAF 21-0960-J-4--15,000
(n) VAF 21-0960-L-1--20,000
(o) VAF 21-0960-N-3--5,000
(p) VAF 21-0960-N-4--20,000
(q) VAF 21-0960-Q-1--10,000

    Dated: December 15, 2014.

    By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, Department of Veterans Affairs.
[FR Doc. 2014-29630 Filed 12-17-14; 8:45 am]
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