[Federal Register Volume 82, Number 16 (Thursday, January 26, 2017)]
[Notices]
[Pages 8566-8567]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-01753]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]


Proposed Information Collection Activity: (Income Verification)

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 
this new 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 March 27, 2017.

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-NEW'' 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:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1
    c. Mailed to Veterans When Necessary--HEC Form 340-1
    d. Mailed to Veterans When Necessary--Checklist.
    OMB Control Number: 2900-NEW.
    Type of Review: New collection.
    Abstract: The HEC, IVD uses HEC Form 200-1A (Veteran's Income 
Verification Response) to collect income verification information, as 
applicable, from the Veteran by requesting the

[[Page 8567]]

Veteran to verify the listed income on the form as reported to IVD by 
IRS/SSA, to select the appropriate option on the form relating to the 
household income, attest to out of pocket medical expenses, attest to 
sale of primary home real estate and attest to separation from spouse 
for the income year under the Income Verification Division's review. 
The Veteran's signature is required on page 2 of HEC Form 200-1A. If 
the Veteran has medical/health limitations that does not enable the 
Veteran to physically sign the form with a wet signature, the Veteran 
must mark an ``X'' to designate a signature; two witnesses must verify 
the ``X'' as the Veteran's signature. HEC, IVD will use the completed 
HEC Form 200-1A to assist in verifying the Veteran's correct gross 
household income to ensure the Veteran is placed in the correct 
priority group for health care.
    The HEC, IVD uses HEC Form 220-1 (Spouse's Income Verification 
Response) to collect income verification information, as applicable, 
from the Veteran's spouse by requesting the spouse to verify the listed 
income on the form as reported to IVD by IRS/SSA, report any additional 
income not reported by IRS/SSA and sign and date the form. If the 
spouse has medical/health limitations that does not enable the spouse 
to physically sign the form with a wet signature, the spouse must mark 
an ``X'' to designate a signature; two witnesses must verify the ``X'' 
as the Veteran's signature. HEC, IVD will use the completed HEC Form 
220-1 to assist in verifying the Veteran's correct gross household 
income to ensure the Veteran is placed in the correct priority group 
for health care.
    The HEC, IVD uses the HEC Form 340-1 (Declaration of 
Representative) for the Veteran and the spouse (if applicable) to 
appoint a representative, authorizing HEC, IVD to release information 
to a designated appointee for a specific income year. Such information 
includes confidential federal tax information, other income, and 
medical benefits eligibility related information. The Veteran and 
spouse (if applicable) must sign and date the form.
    The HEC, IVD uses the HEC Income Verification--Additional 
Information Checklist to request from the Veteran any additional 
information needed to adjudicate the Income Verification case. The 
Veteran providing the requested information usually results in the best 
interest to the Veteran.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--89,001 
hours
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--28,530 
hours
    c. Mailed to Veterans When Necessary--HEC Form 340-1--1,701 hours
    d. Mailed to Veterans When Necessary--Checklist--761 hours
    Estimated Average Burden per Respondent:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--30 
minutes
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--20 minutes
    c. Mailed to Veterans When Necessary--HEC Form 340-1--15 minutes
    d. Mailed to Veterans When Necessary--Checklist--761--15 minutes
    Frequency of Response: Annually.
    Estimated Annual Responses:
    a. Mailed with Veterans' Initial Letters--HEC Form 200-1A--178,002
    b. Mailed with Spouses' Initial Letters--HEC Form 220-1--85,590
    c. Mailed to Veterans When Necessary--HEC Form 340-1--6,805
    d. Mailed to Veterans When Necessary--Checklist--761--3,044

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Program Specialist, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-01753 Filed 1-25-17; 8:45 am]
 BILLING CODE 8320-01-P