[Federal Register Volume 66, Number 103 (Tuesday, May 29, 2001)]
[Notices]
[Pages 29208-29209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-13423]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0080]
Proposed Information Collection Activity: Proposed Collection;
Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: The Veterans Health Administration (VHA) 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 revision of a currently approved collection, and allow 60
days for public comment in response to the notice. This notice solicits
comments on information needed to initiate and document expenditures,
claim reimbursement as well as make funeral arrangements and authorize
burial benefits.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before July 30, 2001.
ADDRESSES: Submit written comments on the collection of information to
Ann Bickoff, Veterans Health Administration (193B1), Department of
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail [email protected]. Please refer to ``OMB Control No. 2900-
0080'' in any correspondence.
FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Public Law 104-13; 44
U.S.C., 3501-3520), 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.
Titles:
a. Claim for Payment of Cost of Unauthorized Medical Services, VA
Form 10-583.
b. Funeral Arrangements, VA Form 10-2065.
c. Authority and Invoice for Travel by Ambulance or Other Hired
Vehicle, VA Form 10-2511.
d. Authorization and Invoice for Medical and Hospital Services.
OMB Control Number: 2900-0080.
Type of Review: Revision of a currently approved collection.
Abstract:
a. VA Form 10-583 is used by health care providers as a claim for
the cost of unauthorized hospital care and by veterans as a claim for
reimbursement of such cost.
b. VA Form 10-0265 is completed by clerical staff upon the death of
a veteran in a VA medical care facility. It is used primarily in VA
medical facilities and serves as an official record of the Funeral
Director to which the person making funeral arrangements wishes the
remains to be released. It is also used as a control document when VA
is requested to arrange for the transportation of the deceased from the
place of death to the place of burial, and/or when burial is requested
in a National Cemetery.
c. VA Form 10-7078 is used by administrative personnel in VA
medical facilities to authorize expenditures from the medical care
account and process payment of medical and hospital services provided
by other than Federal health providers to VA beneficiaries.
d. VA Form 10-2511 is used by administrative personnel in VA
facilities to authorize expenditures from the beneficiary travel
account. It is also used to process payment for ambulance or other
hired vehicular forms of transportation for eligible veterans to and
from VA health care facilities for examination, treatment or care.
Affected Public: Business or other for profit, Individuals or
households, and Not for profit institutions.
Estimated Total Annual Burden: 32,742 hours.
a. VA Form 10-583--17,188.
b. VA Form 10-2065--3,071.
c. VA Form 10-2511--4,083.
d. VA Form 10-7078--8,400.
Estimated Average Burden Per Respondent:
a. VA Form 10-583--15 minutes.
b. VA Form 10-2065--5 minutes.
c. VA Form 10-2511--2 minutes.
[[Page 29209]]
d. VA Form 10-7078--2 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 480,100.
a. VA Form 10-583--68,750 hours.
b. VA Form 10-2065--36,850 hours.
c. VA Form 10-2511--122,500 hours.
d. VA Form 10-7078--252,000 hours.
Dated: May 18, 2001.
By direction of the Secretary.
Barbara H. Epps,
Management Analyst, Information Management Service.
[FR Doc. 01-13423 Filed 5-25-01; 8:45 am]
BILLING CODE 8320-01-P