[Federal Register Volume 76, Number 183 (Wednesday, September 21, 2011)]
[Notices]
[Pages 58566-58567]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-24197]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0104]
Proposed Information Collection (Report of Accidental Injury in
Support of Claim for Compensation or Pension/Statement of Witness to
Accident) Activity: Comment Request
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
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SUMMARY: The Veterans Benefits Administration (VBA), Department of
Veterans Affairs (VA), 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 this notice. This notice solicits comments on the
information needed to support a claim for disability benefits based on
an accidental injury.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before November 21, 2011.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits
Administration (20M33), Department of Veterans Affairs, 810 Vermont
Avenue, NW., Washington, DC 20420 or e-mail [email protected].
Please refer to ``OMB Control No. 2900-0104'' in any correspondence.
During the comment
[[Page 58567]]
period, comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 461-9769
or FAX (202) 275-5947.
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, VBA
invites comments on: (1) Whether the proposed collection of information
is necessary for the proper performance of VBA's functions, including
whether the information will have practical utility; (2) the accuracy
of VBA'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: Report of Accidental Injury in Support of Claim for
Compensation or Pension/Statement of Witness to Accident, VA Form 21-
4176.
OMB Control Number: 2900-0104.
Type of Review: Extension of a currently approved collection.
Abstract: VA Form 21-4176 is used to support a claim for disability
benefits based on an accidental injury that a veteran incurred while in
the line of duty. VA will use the data collected to determine whether
the injury was accidental or a result of willful misconduct by the
veteran.
Affected Public: Individuals or households.
Estimated Annual Burden: 2,200 hours.
Estimated Average Burden per Respondent: 30 minutes.
Frequency of Response: One-time.
Estimated Number of Respondents: 4,400.
By direction of the Secretary:
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-24197 Filed 9-20-11; 8:45 am]
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