[Federal Register Volume 82, Number 125 (Friday, June 30, 2017)]
[Notices]
[Page 30004]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-13731]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900--NEW]


Agency Information Collection Activity: General Release for 
Medical Provider Information to the Department of Veterans Affairs (VA) 
and Authorization and Consent To Release Information to the Department 
of Veterans Affairs

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: Veterans Benefits Administration, 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 extension of a 
currently approved collection, and allow 60 days for public comment in 
response to the notice.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before August 29, 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--NEW'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-
5870.

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. 3501-3521.

    Title: General Release for Medical Provider Information to the 
Department of Veterans Affairs (VA) (VA Form 21-4142) and Authorization 
and Consent to Release Information to the Department of Veterans 
Affairs (VA Form 21-4142a).
    OMB Control Number: 2900--NEW.
    Type of Review: New collection.
    Abstract: VA Forms 21-4142 will be used to authorize the disclosure 
of information to the VA and 21-4142a will be used to gather the 
necessary information to request medical provider information to the 
VA.
    Affected Public: Individuals and households.
    Estimated Annual Burden: 11,033 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 132,400.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of Privacy and Records Management, 
Department of Veterans Affairs.
[FR Doc. 2017-13731 Filed 6-29-17; 8:45 am]
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