[Federal Register Volume 82, Number 227 (Tuesday, November 28, 2017)]
[Notices]
[Pages 56332-56333]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-25592]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0776]


Agency Information Collection Activity Under OMB Review: 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: 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 December 28, 2017.

ADDRESSES: Submit written comments on the collection of information 
through 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-
0776'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department of Veterans Affairs, 811 Vermont 
Avenue NW., Washington, DC 20420, (202) 461-5870 or email 
[email protected]. Please refer to ``OMB Control No. 2900-
0776'' in any correspondence.

SUPPLEMENTARY INFORMATION:

    Authority:  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 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. 
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-

[[Page 56333]]

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.
    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 79 on April 26, 2017, pages 19311 
and 19312.
    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, Office of Quality, Privacy and Risk, 
Department of Veterans Affairs.
[FR Doc. 2017-25592 Filed 11-27-17; 8:45 am]
 BILLING CODE 8320-01-P