[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Pages 19311-19312]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-08440]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0776]


Agency Information Collection Activity: Artery and Vein 
Conditions (Vascular Diseases Including Varicose Veins) Disability 
Benefits Questionnaire, Hypertension Disability Benefits Questionnaire, 
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) 
Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy 
(Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits 
Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire, 
Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases 
Disability Benefits Questionnaire, Amputations Disability Benefits 
Questionnaire, Muscles Injuries Disability Benefits Questionnaire, 
Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire, Eye Conditions Disability Benefits Questionnaire

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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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 21-0960A-
2, Artery and Vein Conditions vascular diseases including varicose 
veins) Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of arteries, veins, and/or 
peripheral vascular disease; VAF 21-0960A-3, Hypertension, Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of hypertension; VAF 21-0960A-4, Non-ischemic 
Heart Disease (including Arrhythmias and Surgery) Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of any non-ischemic heart disease; VAF 21-0960C-4, Diabetic 
Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy) 
Disability Benefits Questionnaire will gather information related to 
the claimant's diagnosis of a diabetic sensory-motor peripheral 
neuropathy condition; VAF 21-0960E-1, Diabetes Mellitus Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of diabetes mellitus; VAF 21-0960F-1, Scars/
Disfigurement Disability Benefits Questionnaire will gather information 
related to the claimant's diagnosis of any scars or disfigurement; VAF 
21-0960F-2, Skin Diseases Disability Benefits Questionnaire, will 
gather information related to the claimant's diagnosis of any skin 
disease. VAF 21-0960M-1 Amputations Disability Benefits Questionnaire, 
will gather information related to the claimant's amputations; VAF 21-
0960M-10 Muscle Injuries Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of a muscle injury 
disability. VAF 21-0960M-15 Temporomandibular Joint (TMJ) Conditions 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of temporomandibular joint dysfunction or TMJ. 
VAF 21-0960N-2 Eye Conditions Disability Benefits Questionnaire will 
gather information related to the claimant's diagnosis of an eye 
condition.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before June 26, 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. 2900-0776'' in any correspondence. During the comment

[[Page 19312]]

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: (Artery and Vein Conditions (Vascular Diseases Including 
Varicose Veins) Disability Benefits Questionnaire (VA Form 21-0960A-2), 
Hypertension Disability Benefits Questionnaire (VA Form 21-0960A-3), 
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery) 
Disability Benefits Questionnaire (VA Form 21-0960A-4), Diabetic 
Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy) 
Disability Benefits Questionnaire (VA Form 21-0960C-4), Diabetes 
Mellitus Disability Benefits Questionnaire (VA Form 21-0960E-1), Scars/
Disfigurement Disability Benefits Questionnaire (VA Form 21-0960F-1), 
Skin Diseases Disability Benefits Questionnaire (VA Form 21-0960F-2), 
Amputations Disability Benefits Questionnaire (VA Form 21-0960M-1), 
Muscles Injuries Disability Benefits Questionnaire (VA Form 21-0960M-
10), Temporomandibular Joint (TMJ) Conditions Disability Benefits 
Questionnaire (VA Form 21-0960M-15), Eye Conditions Disability Benefits 
Questionnaire (VA Form 21-0960N-2)).
    OMB Control Number: 2900-0776.
    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 21-0960A-2, Artery and Vein Conditions vascular diseases including 
varicose veins) Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of arteries, veins, 
and/or peripheral vascular disease; VAF 21-0960A-3, Hypertension, 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of hypertension; VAF 21-0960A-4, Non-ischemic 
Heart Disease (including Arrhythmias and Surgery) Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of any non-ischemic heart disease; VAF 21-0960C-4, Diabetic 
Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy) 
Disability Benefits Questionnaire will gather information related to 
the claimant's diagnosis of a diabetic sensory-motor peripheral 
neuropathy condition; VAF 21-0960E-1, Diabetes Mellitus Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of diabetes mellitus; VAF 21-0960F-1, Scars/
Disfigurement Disability Benefits Questionnaire will gather information 
related to the claimant's diagnosis of any scars or disfigurement; VAF 
21-0960F-2, Skin Diseases Disability Benefits Questionnaire, will 
gather information related to the claimant's diagnosis of any skin 
disease. VAF 21-0960M-1 Amputations Disability Benefits Questionnaire, 
will gather information related to the claimant's amputations; VAF 21-
0960M-10 Muscle Injuries Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of a muscle injury 
disability. VAF 21-0960M-15 Temporomandibular Joint (TMJ) Conditions 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of temporomandibular joint dysfunction or TMJ. 
VAF 21-0960N-2 Eye Conditions Disability Benefits Questionnaire will 
gather information related to the claimant's diagnosis of an eye 
condition.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 162,500.
    Estimated Average Burden per Respondent: 25 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 400,000.

    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. 2017-08440 Filed 4-25-17; 8:45 am]
 BILLING CODE 8320-01-P