[Federal Register Volume 85, Number 209 (Wednesday, October 28, 2020)]
[Notices]
[Pages 68418-68419]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-23808]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0091]


Agency Information Collection Activity: VA Health Benefits: 
Application, Update, and Hardship Determination

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Veterans Health 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 December 28, 2020.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov 
or to Brian McCarthy, Office of Regulatory and Administrative Affairs 
(10B4), Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420 or email to [email protected]. Please refer 
to ``OMB Control No. 2900-0091'' in any correspondence. During the 
comment period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 615-9241.

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, VHA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA'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: VA Health Benefits: Application, Update, and Hardship 
Determination, VA Forms 10-10EZ, 10-10EZR and 10-10HS.
    OMB Control Number: 2900-0091.
    Type of Review: Extension of a currently approved collection.
    Abstract: Title 38 U.S.C. Chapter 17 authorizes VA to provide 
hospital care, medical services, domiciliary care, and nursing home 
care to eligible Veterans. Title 38 U.S.C. 1705 requires VA to design, 
establish, and operate a system of annual patient enrollment in 
accordance with a series of stipulated priorities. Title 38 U.S.C. 1722 
establishes eligibility assessment procedures for cost-free VA medical 
care, based on income levels, which determines whether nonservice-
connected and 0% service-connected non-compensable Veterans are able to 
defray the necessary expenses of care for nonservice-connected 
conditions. Further, when the Veteran projects that his or her 
attributable income for the current calendar year would be 
substantially below the applicable income thresholds, the Veteran would 
be considered unable to defray the expenses of care and VA may exempt 
the Veteran from the requirement to pay copayments for hospital or 
outpatient care.
    This collection of information is required to properly administer 
health benefits to eligible Veterans.

[[Page 68419]]

    a. VA Form 10-10EZ, Application for Health Benefits, is used to 
collect Veteran information during the initial application process for 
VA medical care, nursing home, domiciliary, dental benefits, etc.
    b. VA Form 10-10EZR, Health Benefits Update Form, is used to update 
a Veteran's personal information, such as marital status, address, 
health insurance and financial information, for renewal of health 
benefits.
    c. VA Form 10-10HS, Request for Hardship Determination, is used to 
collect information from Veterans who are in a copay required status 
for hospital care and medical services, but due to a loss of income 
project their income for the current year will be substantially below 
the VA means test limits.
    These forms collect information to enroll a Veteran for health 
benefits, establish basic eligibility, identify 3rd party health 
insurance coverage, identify prescription copayment, provide for income 
verification, and serve as a mechanism to make changes upon admission 
for benefits or yearly financial updates.

VA Form 10-10EZ

    Affected Public: Individuals and households.
    Estimated Annual Burden: 270,000 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: Annually.
    Estimated Number of Respondents: 540,000.

VA Form 10-10EZR

    Affected Public: Individuals and households.
    Estimated Annual Burden: 343,600 hours.
    Estimated Average Burden per Respondent: 24 minutes.
    Frequency of Response: Annually.
    Estimated Number of Respondents: 859,000.

VA Form 10-10HS

    Affected Public: Individuals and households.
    Estimated Annual Burden: 1,750 hours.
    Estimated Average Burden per Respondent: 15 minutes.
    Frequency of Response: Annually.
    Estimated Number of Respondents: 7,000.

    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. 2020-23808 Filed 10-27-20; 8:45 am]
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