[Federal Register Volume 78, Number 112 (Tuesday, June 11, 2013)]
[Notices]
[Page 35099]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-13723]
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0188]
Proposed Information Collection Activity: [Claim, Authorization
and Invoice for Prosthetic Items and Services]; Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
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 revision 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 and authorize
funding for various prosthetic services.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before August 12, 2013.
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 (10B4), Department of Veterans Affairs, 810 Vermont
Avenue NW., Washington, DC 20420 or email: [email protected].
Please refer to ``OMB Control No. 2900-0188'' in any correspondence.
During the comment period, comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-5870
or Fax (202) 495-5397.
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) Request to Submit Quotation, Form Letter 10-90.
(b) Veterans Application for Assistance in Acquiring Home
Improvement and Structural Alterations, VA Form 10-0103.
(c) Application for Adaptive Equipment Motor Vehicle, VA Form 10-
1394.
(d) Prosthetic Authorization for Items or Services, VA Form 10-
2421.
(e) Prosthetic Service Card Invoice, VA Form 10-2520.
(f) Prescription and Authorization for Fee Basis Eyeglasses, VA
Form 10-2914.
OMB Control Number: 2900-0188.
Type of Review: Revision of a currently approved collection.
Abstract: The following forms will are used to determine
eligibility, prescribe and authorize prosthetic devices:
a. VA Form Letter 10-90 is used to obtain to estimated price for
prosthetic devices.
b. VA Form 10-0103 is used to determine eligibility/entitlement and
reimbursement of individual claims for home improvement and structural
alterations.
c. VA Form 10-1394 is used to determine eligibility/entitlement and
reimbursement of individual claims for automotive adaptive equipment.
d. VA Form 10-2421 is used for the direct procurement of new
prosthetic appliances and/or services. The form standardizes the direct
procurement authorization process, eliminating the need for separate
purchase orders, expedites patient treatment and improves the delivery
of prosthetic services.
e. VA Form 10-2520 is used by the vendors as an invoice and billing
document. The form standardizes repair/treatment invoices for
prosthetic services rendered and standardizes the verification of these
invoices. The Veteran certifies that the repairs were necessary and
satisfactory. This form is furnished to vendors upon request.
f. VA Form 10-2914 is used as a combination prescription,
authorization and invoice. It allows veterans to purchase their
eyeglasses directly. If the form is not used, the provisions of
providing eyeglasses to eligible Veterans may be delayed.
Affected Public: Individuals or households.
Estimated Total Annual Burden: 5,738.
(a) Form Letter 10-90--708.
(b) VA Form 10-0103--583.
(c) VA Form 10-1394--1,000.
(d) VA Form 10-2421--67.
(e) VA Form 10-2520--47.
(f) VA Form 10-2914--3,333.
Estimated Average Burden per Respondent:
(a) Form Letter 10-90--5 minutes.
(b) VA Form 10-0103--5 minutes.
(c) VA Form 10-1394--15 minutes.
(d) VA Form 10-2421--4 minutes.
(e) VA Form 10-2520--4 minutes.
(f) VA Form 10-2914--4 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 71,200.
a. Form Letter 10-90--8,500.
c. VA Form 10-0103--7,000.
d. VA Form 10-1394--4,000.
e. VA Form 10-2421--1,000.
f. VA Form 10-2520--700.
g. VA Form 10-2914--50,000.
Dated: June 5, 2013.
By direction of the Secretary:
Crystal Rennie,
VA Clearance Officer, Office of Information and Technology, U.S.
Department of Veterans Affairs.
[FR Doc. 2013-13723 Filed 6-10-13; 8:45 am]
BILLING CODE 8320-01-P