[Federal Register Volume 86, Number 28 (Friday, February 12, 2021)]
[Notices]
[Pages 9425-9426]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02885]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0091]


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

AGENCY: Veterans Health 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 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: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function. Refer to 
``OMB Control No. 2900-0091.

FOR FURTHER INFORMATION CONTACT: Maribel Aponte, Office of Enterprise 
and Integration, Data Governance Analytics (008), 1717 H Street NW, 
Washington, DC 20006, (202) 266-4688 or email [email protected]. 
Please refer to ``OMB Control No. 2900-0091'' in any correspondence.

SUPPLEMENTARY INFORMATION:
    Authority: 44 U.S.C. 3501-21.
    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.
    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.
    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 85 FR 209 on October 28, 2020, pages 68418 
and 68419.

[[Page 9426]]

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.
Maribel Aponte,
VA PRA Clearance Officer, Office of Enterprise and Integration, Data 
Governance Analytics, Department of Veterans Affairs.
[FR Doc. 2021-02885 Filed 2-11-21; 8:45 am]
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