[Federal Register Volume 88, Number 208 (Monday, October 30, 2023)]
[Notices]
[Pages 74247-74248]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-23873]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0883]


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.

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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. 2900-0883.''

FOR FURTHER INFORMATION CONTACT: Maribel Aponte, Office of Enterprise 
and Integration, Data Governance Analytics (008), 810 Vermont Avenue 
NW, Washington, DC 20420, (202) 266-4688 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0883'' in 
any correspondence.

SUPPLEMENTARY INFORMATION: 
    Authority: 44 U.S.C. 3501-3521.
    Title: Per Diem to States for Care of Eligible Veterans in State 
Homes (VA Forms 10-0143, 10-0143A, 10-0144, 10-0144A, 10-0460a, and 10-
3567).
    OMB Control Number: 2900-0883.
    Type of Review: Revision of a currently approved collection.
    Abstract: Authority for this information collection is from title 
38 Code of Federal Regulations (CFR) part 51, Per Diem for Nursing 
Home, Domiciliary or Adult Day Health Care of Veterans in State 
Veterans Homes, requiring the VA to ensure that per diem payments are 
limited to facilities providing high quality care for Veterans. This 
collection of forms is approved under OMB Control Number 2900-0883.
    These six forms (10-0143, 10-0143A, 10-0144, 10-0144A, 10-0460a, 
and 10-3567) are presented to and completed by State Veterans Homes 
(SVH) management under subpart B of the CFR part 51 and then assessed 
for compliance to applicable regulations under subparts D, E or F by VA 
contracted vendors during a VA survey at each State Veterans Home (SVH) 
across the U.S. as a regulatory action. This collection of forms falls 
under the auspices of The Office of Geriatrics and Extended Care in VA 
Central Office (12GEC). As per VHA Directive 1145.01, this collection 
of forms is part of the VA survey process. The legal requirements that 
necessitate this collection of information are found specifically at 
title 38 CFR 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 10-0460a--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 Home will submit to the VA medical center of 
jurisdiction a monthly completed VA Form 10-0460a 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

[[Page 74248]]

soliciting comments on this collection of information was published at 
88 FR 164 on August 25, 2023, pages 58439 and 58440.
    Total Annual Burden: 2,119 hours.
    Total Annual Responses: 2,805.

VA Form 10-0143

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 13.75 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 165.

VA Form 10-0143A

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 13.75 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 165.

VA Form 10-0144

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 13.75 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 165.

VA Form 10-0144A

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 13.75 hours.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 165.

VA Form 10-0460a

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 1980 hours.
    Estimated Average Burden per Respondent: 60 minutes.
    Frequency of Response: Monthly.
    Estimated Number of Respondents: 165.

VA Form 10-3567

    Affected Public: State, local, and Tribal governments.
    Estimated Annual Burden: 82.50 hours.
    Estimated Average Burden per Respondent: 30 minutes.
    Frequency of Response: Once annually.
    Estimated Number of Respondents: 165.

    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. 2023-23873 Filed 10-27-23; 8:45 am]
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