[Federal Register Volume 84, Number 234 (Thursday, December 5, 2019)]
[Notices]
[Pages 66706-66707]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-26233]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0778]


Agency Information Collection Activity: Disability Benefits 
Questionnaire (Group 3)

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

[[Page 66707]]

concerning each proposed collection of information, including each 
proposed reinstatement 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 February 3, 2020.

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. 2900-0778'' in any correspondence. During the comment period, 
comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Danny 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 Questionnaires (Group 3).
    OMB Control Number: 2900-0778.
    Type of Review: Reinstatement of a currently approved collection.
    Abstract: VA Form 21-0960 series called Disability Benefits 
Questionnaire (Group 3) gathers 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 Benefit Questionnaires (Group 3) is comprised of 17 forms. 
Each DBQ title includes the names of the specific disability for which 
it gathers information. VAF 21-0960C-5, Central Nervous System and 
Neuromuscular Diseases Disability Benefits Questionnaire, gathers 
information related to the claimant's diagnosis of a central nervous 
system disease; VAF 21-0960C-8, Headaches (Including Migraine 
Headaches) Disability Benefits Questionnaire, gathers information 
related to the claimant's diagnosis of headaches; VAF 21-0960C-9, 
Multiple Sclerosis (MS) Disability Benefits Questionnaire, gathers 
information related to the claimant's diagnosis of multiple sclerosis; 
VAF 21-0960G-1, Esophageal Disorders (including GERD, Hiatal Hernia, 
and Other Esophageal Disorders) Disability Benefits Questionnaire, 
gathers information related to the claimant's diagnosis of any 
esophageal disorders; VAF 21-0960G-2, Gall Bladder and Pancreas 
Conditions Disability Benefits Questionnaire, gathers information 
related to the claimant's diagnosis of any gall bladder and pancreas 
condition; VAF 21-0960G-3, Intestinal Conditions (Other than Surgical 
or Infectious) Including Irritable Bowel Syndrome, Crohn's Disease, 
Ulcerative Colitis, and Diverticulitis Disability Benefits 
Questionnaire, gathers information related to the claimant's diagnosis 
of any intestinal conditions unrelated to surgery or infection; VAF 21-
0960G-4, Infectious Intestinal Disorders (including Bacterial and 
Parasitic Infections) Disability Benefits Questionnaire, gathers 
information related to the claimant's diagnosis of any infectious 
intestinal condition; VAF 21-0960G-5, Hepatitis, Cirrhosis and other 
Liver Conditions Disability Benefits Questionnaire, gathers information 
related to the claimant's diagnosis of any liver condition; VAF 21-
0960G-6, Peritoneal Adhesions Disability Benefits Questionnaire, 
gathers information related to the claimant's diagnosis of peritoneal 
adhesions; VAF 21-0960G-7, Stomach and Duodenum Conditions (Not 
Including GERD or Esophageal Disorders) Disability Benefits 
Questionnaire, gathers information related to the claimant's diagnosis 
of any stomach or duodenum conditions; VAF 21-0960G-8, Intestinal 
Surgery (Bowel Resection, Colostomy, Ileostomy) Disability Benefits 
Questionnaire, gathers information related to the claimant's diagnosis 
of any surgical intestinal condition; VAF 21-0960H-2, Rectum and Anus 
Conditions (Including Hemorrhoids) Disability Benefits Questionnaire, 
gathers information related to the claimant's diagnosis of any rectum 
or anus condition, which includes hemorrhoids; VAF 21-0960K-1, Breast 
Conditions and Disorders Disability Benefits Questionnaire, gathers 
information related to the claimant's diagnosis of a breast condition 
or disorder; VAF 21-0960K-2, Gynecological Conditions Disability 
Benefits Questionnaire, gathers information related to the claimant's 
diagnosis of a gynecological condition; VAF 21-0960L-2, Sleep Apnea 
Disability Benefits Questionnaire, gathers information related to the 
claimant's diagnosis of sleep apnea; VAF 21-0960M-11, Osteomyelitis 
Disability Benefits Questionnaire, gathers information related to the 
claimant's diagnosis of osteomyelitis; and VAF 21-0960N-1, Ear 
Conditions (Including Vestibular and Infectious) Disability Benefits 
Questionnaire, gathers information related to the claimant's diagnosis 
of an ear disease.
    Affected Public: Individuals and households.
    Estimated Annual Burden: 77,500 hours.
    Estimated Average Burden per Respondent: 19.4 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 250,000.

    By direction of the Secretary.
Danny S. Green,
Department Clearance Officer, Office of Quality, Privacy and Risk 
(OQPR), Department of Veterans Affairs.
[FR Doc. 2019-26233 Filed 12-4-19; 8:45 am]
 BILLING CODE 8320-01-P