[Federal Register Volume 76, Number 96 (Wednesday, May 18, 2011)]
[Notices]
[Pages 28851-28852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-12137]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0629]
Proposed Information Collection (Application for Extended Care
Services); 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 extension 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 determine eligibility for
extended care benefits.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before July 18, 2011.
ADDRESSES: Submit written comments on the collection of information
through the Federal Docket Management System (FDMS) at http://www.Regulations.gov; or to Cynthia Harvey-Pryor, Veterans Health
Administration (193E1), Department of Veterans Affairs, 810 Vermont
Avenue, NW., Washington, DC 20420 or e-mail: [email protected]. Please refer to ``OMB Control No. 2900-0629'' in any
correspondence. During the comment period, comments may be viewed
online through FDMS.
FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor (202) 461-5870 or
FAX (202) 273-9387.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C. 3501-3521), 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.
Title: Application for Extended Care Services, VA Form 10-10EC.
OMB Control Number: 2900-0629.
Type of Review: Extension of a currently approved collection.
Abstract: VA Form 10-10EC is used to gather current income and
financial information from nonservice-connected veterans and their
spouse when applying for extended care services and to establish a co-
payment agreement for such services. VA provides extended care to non-
service connected veterans who are unable to defray the necessary
expenses of care if their income is not greater than the maximum annual
pension rate. VA uses the data collected to establish the veteran's
eligibility for extended care services, financial liability, if any, of
the veteran to pay if accepted for placement or treatment in extended
care services, and to determine the appropriate co-payment.
Affected Public: Individuals or Households.
Estimated Total Annual Burden: 9,000 hours.
Estimated Average Burden per Respondent: 90 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 6,000.
[[Page 28852]]
Dated: May 12, 2011.
By direction of the Secretary:
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-12137 Filed 5-17-11; 8:45 am]
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