[Federal Register Volume 82, Number 74 (Wednesday, April 19, 2017)]
[Notices]
[Pages 18537-18538]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-07865]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0802]


Agency Information Collection Activity Under OMB Review: Shoulder 
and Arm Conditions Disability Benefits Questionnaire

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs./AGY>

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
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 May 19, 2017.

ADDRESSES: Submit written comments on the collection of information 
through

[[Page 18538]]

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-
0802'' 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-
0802'' in any correspondence.

SUPPLEMENTARY INFORMATION: 

    Authority: 44 U.S.C. 3501-21.
    Title: Shoulder and Arm Conditions Disability Benefits 
Questionnaire (VA Form 21-0960M-12).
    OMB Control Number: 2900-0802.
    Type of Review: Extension of a currently 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. 
VA Forms 21-0960M-12 is used to gather information related to the 
claimant's diagnosis of a shoulder or arm condition.
    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 82 FR 16, on January 26, 2017, page 8568.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 25,000.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 50,000.

    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. 2017-07865 Filed 4-18-17; 8:45 am]
 BILLING CODE 8320-01-P