[Federal Register Volume 84, Number 87 (Monday, May 6, 2019)]
[Notices]
[Pages 19831-19832]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-09203]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0781]


Agency Information Collection Activity: Disability Benefits 
Questionnaire (Group 4)

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 July 5, 2019.

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. 2900-0781'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Danny S. Green at (202) 421-1354.

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: Disability Benefits Questionnaire (Group 4).
    OMB Control Number: 2900-0781.
    Type of Review: Extension of a currently approved collection.
    Abstract: The VA Form 21-0960 series will be used to gather 
necessary information from a claimant's treating physician regarding 
the results of medical examinations. VA will gather medical information 
related to the claimant that is necessary to adjudicate the claim for 
VA disability benefits. The Disability Benefits Questionnaire title 
will include the name of the specific disability for which it will 
gather information. The Disability Benefit Questionnaire Group 4 
includes the following forms: VA Form 21-0960C-3, Cranial Nerve 
Conditions Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of any cranial nerve condition; VA 
Form 21-0960C-6, Narcolepsy Disability Benefits Questionnaire, will 
gather information related to the claimant's diagnosis of narcolepsy; 
VA Form 21-0960C-7, Fibromyalgia Disability Benefits Questionnaire, 
will gather information related to the claimant's diagnosis of 
fibromyalgia; VA Form 21-0960C-11, Seizure Disorders (Epilepsy) 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of any seizure disorder including epilepsy; VA 
Form 21-0960D-1, Oral and Dental Conditions Including Mouth, Lips and 
Tongue (Other than Temporomandibular Joint Conditions) Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of any oral or dental conditions; VA Form 21-
0960E-2, Endocrine Diseases (Other than Thyroid, Parathyroid, or 
Diabetes Mellitus) Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of any endocrine 
disease including cushings and acromegaly, however it excludes 
diabetes; VA Form 21-0960E-3, Thyroid and Parathyroid Conditions 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of any thyroid or parathyroid condition; VA 
Form 21-0960H-1, Hernias (Including Abdominal, Inguinal, and Femoral 
hernias) Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of abdominal, inguinal, or femoral 
hernias; VA Form 21-0960I-2, HIV-Related Illness Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of any HIV-related illness; VA Form 21-0960I-3, Infectious 
Diseases Other Than HIV-Related Illness, Chronic Fatigue Syndrome, and 
Tuberculosis Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of any infectious diseases; VA Form 
21-0960I-4, Systemic Lupus Erythematosus (SLE) and other Autoimmune 
Diseases Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of lupus or other immune disorders; 
VA Form 21-0960I-5, Nutritional Deficiencies Disability Benefits 
Questionnaire, will gather information related to the claimant's 
diagnosis of nutritional deficiencies; VA Form 21-0960J-4, Urinary 
Tract (including Bladder & Urethra) Conditions (excluding Male 
Reproductive System) Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of any urinary tract or 
bladder condition; VA Form 21-0960L-1, Respiratory Conditions (Other 
than Tuberculosis & Sleep Apnea) Disability Benefits Questionnaire, 
will gather information related to the claimant's diagnosis of any 
respiratory condition; VA Form 21-

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0960N-3, Loss of Sense of Smell and/or Taste Disability Benefits 
Questionnaire, will gather information related to the claimant's loss 
of sense of smell and taste; VA Form 21-0960N-4, Sinusitis/Rhinitis and 
Other Conditions of the Nose, Throat, Larynx, and Pharynx Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of sinusitis/rhinitis or other diseases of the 
nose, throat, larynx, or pharynx; VA Form 21-0960Q-1, Chronic Fatigue 
Syndrome Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of chronic fatigue syndrome.
    Affected Public: Individuals and households.
    Estimated Annual Burden: 53,750 hours.
    Estimated Average Burden per Respondent: 18.5 minutes per form (17 
forms).
    Frequency of Response: One-time.
    Estimated Number of Respondents: 160,000.

    By direction of the Secretary.
Danny S. Green,
VA Interim Clearance Officer, Office of Quality, Performance and Risk, 
Department of Veterans Affairs.
[FR Doc. 2019-09203 Filed 5-3-19; 8:45 am]
 BILLING CODE 8320-01-P