[Federal Register Volume 83, Number 4 (Friday, January 5, 2018)]
[Notices]
[Pages 699-700]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-28510]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0779]


Agency Information Collection Activity Under OMB Review: 
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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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 February 5, 2018.

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

[[Page 700]]

electronic mail to [email protected]. Please refer to ``OMB 
Control No. 2900-0779'' 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-
0779'' in any correspondence.

SUPPLEMENTARY INFORMATION: 

    Authority:  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 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 21-0960B-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.
    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 74 on April 19, 2017, pages 18538 
and 18540.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 127,917 hours.
    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, Office of Quality, Privacy and Risk, 
Department of Veterans Affairs.
[FR Doc. 2017-28510 Filed 1-4-18; 8:45 am]
 BILLING CODE 8320-01-P