[Federal Register Volume 84, Number 193 (Friday, October 4, 2019)]
[Notices]
[Pages 53243-53244]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-21695]


-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]


Agency Information Collection Activity Under OMB Review: per Diem 
to States for Care of Eligible Veterans in State Homes

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
this notice announces that the Veterans Health 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 November 4, 2019.

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-
NEW'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Danny S. Green, Office of Quality, 
performance and Risk (OQPR), Department of Veterans Affairs, 810 
Vermont Avenue NW, Washington, DC 20420, (202) 421-1354 or email 
[email protected] Please refer to ``OMB Control No. 2900-NEW'' in any 
correspondence.

SUPPLEMENTARY INFORMATION: 

[[Page 53244]]

    Authority: 44 U.S.C. 3501-21.
    Title: per Diem to States for Care of Eligible Veterans in State 
Homes (VA Forms 10-0143, 10-0143A, 10-0144, 10-0144A, 10-0460, and 10-
3567)
    OMB Control Number: 2900-NEW.
    Type of Review: Reinstatement of previously approved collection as 
a new collection.
    Abstract: This collection of forms was part of a previously 
approved collection under OMB Control Number 2900-0160. However, it has 
been determined that these six forms will be separated from the other 
three forms in 2900-0160, and renewal is requested under a new OMB 
Control Number.
    Title 38 CFR part 51 State Veterans Homes (SVH) regulations 
published in the Federal Register as final rule on November 28, 2018 
(RIN 2900-A088) require the VA to ensure per diem payments are limited 
to facilities providing high quality care. These six forms are 
presented to and completed by SVH management and then assessed and 
utilized by VA SVH Representatives designated by the Medical Center 
Director of VA of jurisdiction during the annual VA survey process at 
each SVH across the U.S. as a regulatory action. This collection of 
forms falls under the auspices of Geriatrics and Extended Care in VA 
Central Office (10NC4). As per VHA Directive 1145.01, this collection 
of forms is part of the annual VA survey process. The legal 
requirements that necessitate this collection of information are found 
specifically at 38 CFR parts 51.31, 51.43, and 51.210 for all three 
levels of care; nursing home, domiciliary, and adult day health care.
    The information required at time of the VA survey includes the 
application and justification for medications for a basic rate Veteran; 
records and reports that SVH management must maintain regarding 
activities of residents or participants; information relating to 
whether the SVH meets standards concerning residents' rights and 
responsibilities prior to admission or enrollment, during admission or 
enrollment, and upon discharge; the records and reports which SVH 
management and SVH health care professionals must maintain regarding 
residents or participants and employees; various types of documents 
pertaining to the management of the SVH; pharmaceutical records; and 
staffing documentation.
    a. VA Form 10-0143--38 CFR 51.210(c)(9)--is used for the annual 
certification pursuant to the Drug-Free Workplace Act of 1988.
    b. VA Form 10-0143A--38 CFR 51.210(c)(8)--is used for annual 
certification from the responsible State Agency showing compliance with 
Section 504 of the Rehabilitation Act of 1973 (Public Law 93-112).
    c. VA Form 10-0144--38 CFR 51.210(c)(10)--is used for annual 
certification regarding lobbying, in compliance with Public Law 101-
121.
    d. VA Form 10-0144A--38 CFR 51.210(c)(11)--is used for annual 
certification of compliance with Title VI of the Civil Rights Act of 
1964, as incorporated in Title 38 CFR 18.1-18.3.
    e. VA Form 10-0460--38 CFR 51.43--As a condition for receiving 
drugs or medicine under this section or under Sec.  17.96 of this 
chapter, the State must submit to the VA medical center of jurisdiction 
a completed VA Form 10-0460 with the corresponding prescription(s) for 
each eligible Veteran.
    f. VA Form 10-3567--38 CFR 51.31--is completed by SVH management 
during the annual VA survey and used to record and then assess the 
following: operating beds versus recognized beds, total FTEE authorized 
and vacancies, as well as resident census.
    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 84 FR 35453 on July 23, 2019, pages 35453 
and 35454.

VA Form 10-0143

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 13 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 156.

VA Form 10-0143A

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 13 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 156.

VA Form 10-0144

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 13 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 156.

VA Form 10-0144A

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 13 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 156.

VA Form 10-0460

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 5500 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 11,000.

VA Form 10-3567

    Affected Public: State, Local, and Tribal Governments.
    Estimated Annual Burden: 78 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 156.

    By direction of the Secretary.
Danny S. Green,
Interim VA Clearance Officer, Office of Quality, performance and Risk 
(OQPR), Department of Veterans Affairs.
[FR Doc. 2019-21695 Filed 10-3-19; 8:45 am]
 BILLING CODE 8320-01-P