[Federal Register Volume 77, Number 148 (Wednesday, August 1, 2012)]
[Notices]
[Pages 45716-45717]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-18727]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0648]
Proposed Information Collection (Foreign Medical Program);
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 reimburse healthcare
providers for medical services provided to veterans with service-
connected disabilities living or traveling overseas.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before October 1, 2012.
ADDRESSES: Submit written comments on the collection of information
through the Federal Docket Management System (FDMS) at
www.Regulations.gov; or to Cynthia Harvey Pryor, Veterans Health
Administration (10P7BFP), Department of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420 or email: [email protected].
Please refer to ``2900-0648'' 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.
Titles:
a. Foreign Medical Program Registration Form, VA Form 10-7959f-1.
b. Claim Cover Sheet--Foreign Medical Program, VA Form 10-7959f-2.
OMB Control Number: 2900-0648.
Type of Review: Extension of a currently approved collection.
Abstracts:
a. Veterans with service connected disabilities living or traveling
overseas complete VA Form 10-7959f-1 to enroll in the Foreign Medical
Program.
b. Healthcare providers complete VA Form 10-7959f-2 to submit
claims for payments or reimbursement of expenses relating to veterans
living or traveling overseas (except for the Philippines) with service-
connected disability. VA will accept provider's generated billing
statement, Uniform Billing--Forms (UB) 04, and Medicare Health
Insurance Claims Form, CMS 1500 for payments or reimbursements.
Affected Public: Individuals or households.
Estimated Total Annual Burden:
a. Foreign Medical Program, VA Form 10-7959f-1--111 hours.
b. Claim Cover Sheet, VA Form 10-7959f-2--3,652 hours.
Estimated Average Burden per Respondent:
a. Foreign Medical Program, VA Form 10-7959f-1--4 minutes.
b. Claim Cover Sheet, VA Form 10-7959f-2--11 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. Foreign Medical Program, VA Form 10-7959f-1--1,660.
b. Claim Cover Sheet, VA Form 10-7959f-2--19,920.
Dated: July 27, 2012.
[[Page 45717]]
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2012-18727 Filed 7-31-12; 8:45 am]
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