[Federal Register Volume 76, Number 191 (Monday, October 3, 2011)]
[Notices]
[Pages 61149-61150]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-25382]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-New (DBQs--Group 4)]
Agency Information Collection (Disability Benefits
Questionnaires--Group 4) 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 November 2, 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 4)'' 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) 461-0966 or e-mail
[email protected]. Please refer to ``OMB Control No. 2900-New (DBQs-
Group 4).''
SUPPLEMENTARY INFORMATION:
Titles:
Cranial Nerve Conditions Disability Benefits Questionnaire, VA Form 21-
0960C3.
Narcolepsy Disability Benefits Questionnaire, VA Form 21-0960C6.
Fibromyalgia Disability Benefits Questionnaire, VA Form 21-0960C7.
Seizure Disorders (Epilepsy) Disability Benefits Questionnaire, VA Form
21-0960C11.
Dental and Oral Conditions, including Mouth, Lips, and Tongue (Other
than Temporomandibular Joint Conditions) Disability Benefits
Questionnaire, VA Form 21-0960D1.
Endocrine Diseases (other than Thyroid, Parathyroid or Diabetes
Mellitus). Disability Benefits Questionnaire, VA Form 21-0960-E-2.
Thyroid & Parathyroid Conditions Disability Benefits Questionnaire, VA
Form 21-0960-E-3.
Hernias (Including Abdominal, Inguinal, and Femoral Hernias) Disability
Benefits Questionnaire, VA Form 21-0960-H-1.
HIV-Related Illnesses Disability Benefits Questionnaire, VA Form 21-
0960-I-2.
Infectious Diseases (Other Than HIV-Related Illness, Chronic Fatigue
Syndrome, or Tuberculosis) Disability Benefits Questionnaire, VA Form
21-0960-I-3.
Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases
Disability Benefits Questionnaire, VA Form 21-0960-I-4.
Nutritional Deficiencies Disability Benefits Questionnaire, VA Form 21-
0960-I-5.
Urinary Tract (including Bladder & Urethra) Conditions (excluding Male
Reproductive System) Disability Benefits Questionnaire, VA Form 21-
0960-J-4.
Respiratory Conditions (other than Tuberculosis and Sleep Apnea)
Disability Benefits Questionnaire, VA Form 21-0960-L-1.
Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire,
VA Form 21-0960-N-3.
Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx,
and Pharynx Disability Benefits Questionnaire, VA Form 21-0960-N-4.
Chronic Fatigue Syndrome Disability Benefits Questionnaire, VA Form 21-
0960-Q-1.
OMB Control Number: 2900-New (DBQs--Group 4).
Type of Review: New collection.
Abstract: Data collected on VA Form 21-0960 series will be used to
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
[[Page 61150]]
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 July 27, 2011, at pages
45008-45008.
Affected Public: Individuals or households.
Estimated Annual Burden:
a. VAF 21-0960-C-3--5,000.
b. VAF 21-0960-C-6--1,250.
c. VAF 21-0960-C-7--1,250.
VAF 21-0960-C-11--1,250.
VAF 21-0960-D-1--1,250.
VAF 21-0960-E-2--2,500.
d. VAF 21-0960-E-3--2,500.
VAF 21-0960-H-1--3,750.
e. VAF 21-0960-I-2--1,250.
f. VAF 21-0960-I-3--2,500.
VAF 21-0960-I-4--2,500.
g. VAF 21-0960-I-5--1,250.
VAF 21-0960-J-4--3,750.
VAF 21-0960-L-1--10,000.
VAF 21-0960-N-3--1,250.
VAF 21-0960-N-4--10,000.
VAF 21-0960-Q-1--2,500.
Estimated Average Burden per Respondent:
a. VAF 21-0960-C-3--30 minutes.
b. VAF 21-0960-C-6--15 minutes.
c. VAF 21-0960-C-7--15 minutes.
VAF 21-0960-C-11--15 minutes.
VAF 21-0960-D-1--15 minutes.
VAF 21-0960-E-2--15 minutes.
d. VAF 21-0960-E-3--15 minutes.
VAF 21-0960-H-1--15 minutes.
e. VAF 21-0960-I-2--15 minutes.
f. VAF 21-0960-I-3--15 minutes.
VAF 21-0960-I-4--30 minutes.
g. VAF 21-0960-I-5--15 minutes.
VAF 21-0960-J-4--15 minutes.
VAF 21-0960-L-1--30 minutes.
VAF 21-0960-N-3--15 minutes.
VAF 21-0960-N-4--30 minutes.
VAF 21-0960-Q-1--15 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VAF 21-0960-C-3--10,000.
b. VAF 21-0960-C-6--5,000.
c. VAF 21-0960-C-7--5,000.
VAF 21-0960-C-11--5,000.
VAF 21-0960-D-1--5,000.
VAF 21-0960-E-2--10,000.
d. VAF 21-0960-E-3--10,000.
VAF 21-0960-H-1--15,000.
e. VAF 21-0960-I-2--5,000.
f. VAF 21-0960-I-3--10,000.
VAF 21-0960-I-4--5,000.
g. VAF 21-0960-I-5--5,000.
VAF 21-0960-J-4--15,000.
VAF 21-0960-L-1--20,000.
VAF 21-0960-N-3--5,000.
VAF 21-0960-N-4--20,000.
VAF 21-0960-Q-1--10,000.
Dated: September 28, 2011.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-25382 Filed 9-30-11; 8:45 am]
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