[Federal Register Volume 76, Number 110 (Wednesday, June 8, 2011)]
[Notices]
[Pages 33417-33418]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-14119]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-New (DBQs--Group 2)]
Agency Information Collection (Disability Benefits
Questionnaires--Group 2) Activity Under OMB Review
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits
Administration (VBA), 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; it includes the actual data collection instrument.
DATES: Comments must be submitted on or before July 8, 2011.
ADDRESSES: Submit written comments on the collection of information
through http://www.Regulations.gov or to VA's OMB Desk Officer, OMB
Human Resources and Housing Branch, New Executive Office Building, Room
10235, Washington, DC 20503 (202) 395-7316. Please refer to ``OMB
Control No. 2900-New (DBQs--Group 2)'' in any correspondence.
FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420, (202) 461-7485, FAX (202) 273-0443 or e-mail
[email protected]. Please refer to ``OMB Control No. 2900-New
(DBQs--Group 2).''
Titles:
a. Arteries and Veins Conditions (Vascular Diseases including
Varicose Veins) Disability Benefits Questionnaire, VA Form 21-0960A-2.
b. Hypertension Disability Benefits Questionnaire, VA Form 21-
0960A-3.
c. Non-ischemic Heart Disease (including Arrhythmias and Surgery,
Disability Benefits Questionnaire, VA Form 21-0960A-4.
d. Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor
Peripheral
[[Page 33418]]
Neuropathy), Disability Benefits Questionnaire, VA Form 21-0960C-4.
e. Diabetes Mellitus Disability Benefits Questionnaire, VA Form 21-
0960E-1.
f. Scar/Disfigurement Disability Benefits Questionnaire, VA Form
21-0960F-1
g. Skin Diseases Disability Benefits Questionnaire, VA Form 21-
0960F-2.
h. Amputations Disability Benefits Questionnaire, VA Form 21-0960M-
1.
i. Ankle Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-2.
j. Elbow and Forearm Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-4.
k. Flatfoot (PES PLANUS) Disability Benefits Questionnaire, VA Form
21-0960M-5.
l. Foot Miscellaneous (other than flatfoot/PES PLANUS), Disability
Benefits Questionnaire, VA Form 21-0960M-6.
m. Hand and Finger Conditions Disability Benefits Questionnaire, VA
Form 21-0960M-7.
n. Hip and Thigh Conditions Disability Benefits Questionnaire, VA
Form 21-0960M-8.
o. Knee and Lower Leg Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-9.
p. Muscle Injuries Disability Benefits Questionnaire, VA Form 21-
0960M-10.
q. Shoulder and Arm Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-12.
r. Temporomandibular Joint (TMJ) Conditions Disability Benefits
Questionnaire, VA Form 21-0960M-15.
s. Wrist Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-16.
t. Eye Conditions Disability Benefits Questionnaire, VA Form 21-
0960N-2.
OMB Control Number: 2900-New (DBQs--Group 2).
Type of Review: New collection.
Abstract: Data collected on VA Form 21-0960 series will be used
obtain information from claimants treating physician that is necessary
to adjudicate a claim for disability benefits.
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 on March 23, 2011, at pages 16478-16479.
Affected Public: Individuals or households.
Estimated Annual Burden:
a. VA Form 21-0960A-2--10,000.
b. VA Form 21-0960A-3--12,500.
c. VA Form 21-0960A-4--10,000.
d. VA Form 21-0960C-4--37,500.
e. VA Form 21-0960E-1--18,750.
f. VA Form 21-0960F-1-- 6,250.
g. VA Form 21-0960F-2--6,250.
h. VA Form 21-0960M-1--12,500.
i. VA Form 21-0960M-2--15,000.
j. VA Form 21-0960M-4--10,000.
k. VA Form 21-0960M-5--12,500.
l. VA Form 21-0960M-6--7,500.
m. VA Form 21-0960M-7--15,000.
n. VA Form 21-0960M-8--25,000.
o. VA Form 21-0960M-9--25,000.
p. VA Form 21-0960M-10--15,000.
q. VA Form 21-0960M-12--25,000.
r. VA Form 21-0960M-15--3,750.
s. VA Form 21-0960M-16--20,000.
t. VA Form 21-0960N-2--30,000.
Estimated Average Burden Per Respondent:
a. VA Form 21-0960A-2--30 minutes.
b. VA Form 21-0960A-3--15 minutes.
c. VA Form 21-0960A-4--30 minutes.
d. VA Form 21-0960C-4--30 minutes.
e. VA Form 21-0960E-1--15 minutes.
f. VA Form 21-0960F-1--15 minutes.
g. VA Form 21-0960F-2--15 minutes.
h. VA Form 21-0960M-1--30 minutes.
i. VA Form 21-0960M-2--30 minutes.
j. VA Form 21-0960M-4--30 minutes.
k. VA Form 21-0960M-5--15 minutes.
l. VA Form 21-0960M-6--15 minutes.
m. VA Form 21-0960M-7--30 minutes.
n. VA Form 21-0960M-8--30 minutes.
o. VA Form 21-0960M-9--30 minutes.
p. VA Form 21-0960M-10--30 minutes.
q. VA Form 21-0960M-12--30 minutes.
r. VA Form 21-0960M-15--15 minutes.
s. VA Form 21-0960M-16--30 minutes.
t. VA Form 21-0960N-2--45 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VA Form 21-0960A-2--20,000.
b. VA Form 21-0960A-3--50,000.
c. VA Form 21-0960A-4--20,000.
d. VA Form 21-0960C-4--75,000.
e. VA Form 21-0960E-1--75,000.
f. VA Form 21-0960F-1--25,000.
g. VA Form 21-0960F-2--25,000.
h. VA Form 21-0960M-1--25,000.
i. VA Form 21-0960M-2--30,000.
j. VA Form 21-0960M-4--20,000.
k. VA Form 21-0960M-5--50,000.
l. VA Form 21-0960M-6--30,000.
m. VA Form 21-0960M-7--30,000.
n. VA Form 21-0960M-8--50,000.
o. VA Form 21-0960M-9--50,000.
p. VA Form 21-0960M-10--30,000.
q. VA Form 21-0960M-12--50,000.
r. VA Form 21-0960M-15--15,000.
s. VA Form 21-0960M-16--40,000.
t. VA Form 21-0960N-2--40,000.
Dated: June 3, 2011.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-14119 Filed 6-7-11; 8:45 am]
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