[Federal Register Volume 81, Number 165 (Thursday, August 25, 2016)]
[Notices]
[Page 58558]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-20364]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0652]


Agency Information Collection (Request for Nursing Home 
Information in Connection With Claim for Aid and Attendance (VA Form 
21-0779))

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. 3501-21), this notice announces that the Veterans Benefits 
Administration, 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 it includes the actual data collection instrument.

DATES: Comments must be submitted on or before September 26, 2016.

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-
0652'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department of Veterans Affairs, 810 Vermont 
Avenue NW., Washington, DC 20420, (202) 461-5870 or email 
[email protected]. Please refer to ``OMB Control No. 2900-
0652'' in any correspondence.

SUPPLEMENTARY INFORMATION: 
    Title: Request for Nursing Home Information in connection with 
Claim for Aid and Attendance (VA Form 21-0779).
    OMB Control Number: 2900-0652.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA Form 21-0779 is used to gather the necessary 
information to determine eligibility for pension and aid and attendance 
benefits based on nursing home status. The form also requests 
information regarding Medicaid status and nursing home care charges, so 
VA can determine the proper rate of payment.
    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 at 81 FR 109, on June 7, 2016, pages 36659 
and 36660.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 10,188.
    Estimated Average Burden per Respondent: 10 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 61,125.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Program Analyst, Office of Privacy and Records Management, Department 
of Veterans Affairs.
[FR Doc. 2016-20364 Filed 8-24-16; 8:45 am]
 BILLING CODE 8320-01-P