[Federal Register Volume 80, Number 148 (Monday, August 3, 2015)]
[Notices]
[Pages 46104-46105]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18925]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0648]


Proposed Information Collection (Foreign Medical Program 
Application and Claim Cover Sheet) Activity: Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA) 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 extension of a currently approved collection, and allow 
60 days for public comment in response to the notice. This notice 
solicits comments on information needed to identify areas for 
improvement in clinical training programs.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 2, 2015.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at 
www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and 
Administrative Affairs, 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. 2900-0648'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461-6345.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), Federal agencies must obtain approval from 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:
    1. Foreign Medical Program (FMP) Registration Form.
    2. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP).
    OMB Control Number: 2900-0648.
    Type of Review: Extension of a currently approved collection.
    Abstracts: This information collection is needed to carry out the 
health care benefits allowed by the Foreign Medical Program (FMP). It 
is a federal health benefits program for Veterans administered by the 
Department of Veterans Affairs (VA) Veterans Health Administration 
(VHA). FMP is a Fee for Service (indemnity plan) program. FMP provides 
reimbursement for VA adjudicated service-connected conditions. Title 38 
CFR 17.35 states that the VA will provide coverage for the Veteran's 
service-connected disability when the Veteran is residing or traveling 
overseas.
    VA Form 10-7959f-1, Foreign Medical Program (FMP) Registration 
Form, is used to register into the Foreign Medical Program those 
Veterans with service-connected disabilities that are living or 
traveling overseas. Title 38 CFR 17.125(d) states that requests for 
consideration of claim reimbursement from approved health care 
providers and Veterans are to be mailed to VHA Health Administration 
Center (HAC). The VA Form 10-7959f-2, Claim Cover Sheet--Foreign 
Medical Program streamlines the claims submission process for claimants 
or physicians while also reducing the time spent by VA on processing 
FMP claims. The cover sheet will allow foreign providers/Veterans with 
a better understanding of basic information required for the processing 
and payment of claims.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--111 hours.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--3,652 hours.
    Estimated Average Burden per Respondent:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--4 minutes.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--11 minutes.
    Frequency of Response:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--Annually
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2 --12 times a year.
    Estimated Annual Responses:
    a. Foreign Medical Program (FMP) Registration Form--fill, VA Form 
10-7959f-1--1,660.
    b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form 
10-7959f-2--19,920.


[[Page 46105]]


    By direction of the Secretary.
Kathleen M. Manwell,
Program Analyst, VA Privacy Service, Office of Privacy and Records 
Management, Department of Veterans Affairs.
[FR Doc. 2015-18925 Filed 7-31-15; 8:45 am]
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