[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