[Federal Register Volume 82, Number 74 (Wednesday, April 19, 2017)]
[Notices]
[Pages 18538-18540]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-07863]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0779]
Agency Information Collection Activity: Hematologic and Lymphatic
Conditions, Including Leukemia Disability Benefits Questionnaire,
Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability
Benefits Questionnaire, Peripheral Nerve Conditions (Not Including
Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits
Questionnaire, Persian Gulf and Afghanistan Infectious Diseases
Disability Benefits Questionnaire, Tuberculosis Disability Benefits
Questionnaire, Kidney Conditions (Nephrology) Disability Benefits
Questionnaire, Male Reproductive Organ Conditions Disability Benefits
Questionnaire, Prostate Cancer Disability Benefits Questionnaire,
Eating Disorders Disability Benefits Questionnaire, Mental Disorders
(Other Than PTSD and Eating Disorders) Disability Benefits
Questionnaire, Review Post Traumatic Stress Disorder (PTSD) Disability
Benefits Questionnaire
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
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[[Page 18539]]
SUMMARY: The Veterans Benefits Administration (VBA), Department of
Veterans Affairs (VA), 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 revision of
a currently approved collection, and allow 60 days for public comment
in response to the notice.
VA Form 21-0960 series is used to gather necessary information from
a claimant's treating physician regarding the results of medical
examinations. VA gathers medical information related to the claimant
that is necessary to adjudicate the claim for VA disability benefits.
The Disability Benefit Questionnaire title will include the name of the
specific disability for which it will gather information. VAF 21-0960B-
2, Hematologic and Lymphatic Conditions, Including Leukemia Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any hematologic or lymphatic condition; VAF 21-
0960C-2, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of amyotrophic lateral sclerosis; VAF 21-
0960C-10, Peripheral Nerve Conditions (Not Including Diabetic Sensory-
Motor Peripheral neuropathy) Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of a peripheral
nerve disorder; VAF 21-0960I-1, Persian Gulf and Afghanistan Infectious
Diseases Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of an infectious disease due to
service in the Persian Gulf or Afghanistan; VAF 210960-I-6,
Tuberculosis Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of tuberculosis; VAF 21-0960J-1,
Kidney Conditions (Nephrology) Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of kidney
disease; VAF 21-0960J-2, Male Reproductive Organ Conditions Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of a condition affecting the male reproductive
organ; VAF 21-0960J-3, Prostate Cancer Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of prostate cancer; VAF 21-0960P-1, Eating Disorders
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of an eating disorder; VAF 21-0960P-2, Mental
Disorders (other than PTSD and Eating Disorders) Disability Benefits
Questionnaire will gather information related to the claimant's
diagnosis of any mental disorder with the exception of PTSD; VAF 21-
0960P-3, Review Post Traumatic Stress Disorder (PTSD) Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of PTSD.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before June 19, 2017.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at www.Regulations.gov
or to Nancy J. Kessinger, Veterans Benefits Administration (20M33),
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC
20420 or email to [email protected]. Please refer to ``OMB Control
No. 2900-0779'' in any correspondence. During the comment period,
comments may be viewed online through the FDMS.
FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924
or FAX (202) 632-8925.
SUPPLEMENTARY INFORMATION:
Under the PRA of 1995, Federal agencies must obtain approval from
the Office of Management and Budget (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, VBA
invites comments on: (1) Whether the proposed collection of information
is necessary for the proper performance of VBA's functions, including
whether the information will have practical utility; (2) the accuracy
of VBA'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.
Authority: Public Law 104-13; 44 U.S.C. 3501-21.
Title: (Hematologic and Lymphatic Conditions, Including Leukemia
Disability Benefits Questionnaire (VA Form 21-0960B-2), Amyotrophic
Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits
Questionnaire (VA Form 21-0960C-2), Peripheral Nerve Conditions (Not
Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability
Benefits Questionnaire (VA Form 21-0960C-10), Persian Gulf and
Afghanistan Infectious Diseases Disability Benefits Questionnaire (VA
Form 21-0960I-1), Tuberculosis Disability Benefits Questionnaire (VA
Form 21-0960I-6), Kidney Conditions (Nephrology) Disability Benefits
Questionnaire (VA Form 21-0960J-1), Male Reproductive Organ Conditions
Disability Benefits Questionnaire (VA Form 21-0960J-2), Prostate Cancer
Disability Benefits Questionnaire (VA Form 21-0960J-3), Eating
Disorders Disability Benefits Questionnaire (VA Form 21-0960P-1),
Mental Disorders (other than PTSD and Eating Disorders) Disability
Benefits Questionnaire (VA Form 21-0960P-2), Review Post Traumatic
Stress Disorder (PTSD) Disability Benefits Questionnaire (VA Form 21-
0960P-3))
OMB Control Number: 2900-0779.
Type of Review: Extension of an approved collection.
Abstract: VA Form 21-0960 series is used to gather necessary
information from a claimant's treating physician regarding the results
of medical examinations. VA gathers medical information related to the
claimant that is necessary to adjudicate the claim for VA disability
benefits. The Disability Benefit Questionnaire title will include the
name of the specific disability for which it will gather information.
VAF 21-0960B-2, Hematologic and Lymphatic Conditions, Including
Leukemia Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any hematologic or lymphatic
condition; VAF 21-0960C-2, Amyotrophic Lateral Sclerosis (Lou Gehrig's
Disease) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of amyotrophic lateral sclerosis;
VAF 21-0960C-10, Peripheral Nerve Conditions (Not Including Diabetic
Sensory-Motor Peripheral neuropathy) Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of a
peripheral nerve disorder; VAF 21-0960I-1, Persian Gulf and Afghanistan
Infectious Diseases Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of an infectious
disease due to service in the Persian Gulf or Afghanistan; VAF 210960-
I-6, Tuberculosis Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of tuberculosis; VAF
21-0960J-1, Kidney Conditions (Nephrology) Disability
[[Page 18540]]
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of kidney disease; VAF 21-0960J-2, Male
Reproductive Organ Conditions Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of a condition
affecting the male reproductive organ; VAF 21-0960J-3, Prostate Cancer
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of prostate cancer; VAF 21-0960P-1, Eating
Disorders Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of an eating disorder; VAF 21-
0960P-2, Mental Disorders (other than PTSD and Eating Disorders)
Disability Benefits Questionnaire will gather information related to
the claimant's diagnosis of any mental disorder with the exception of
PTSD; VAF 21-0960P-3, Review Post Traumatic Stress Disorder (PTSD)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of PTSD.
Affected Public: Individuals or households.
Estimated Annual Burden: 127,917.
Estimated Average Burden per Respondent: 25 minutes.
Frequency of Response: One time.
Estimated Number of Respondents: 307,000.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-07863 Filed 4-18-17; 8:45 am]
BILLING CODE 8320-01-P