[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]
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