[Federal Register Volume 78, Number 213 (Monday, November 4, 2013)]
[Notices]
[Pages 66105-66106]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-26281]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0091]


Agency Information Collection Activities Under OMB Review

AGENCY: Veterans Health 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 Health 
Administration (VHA), Department of Veterans Affairs, has submitted 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 and includes the actual data collection instrument.

DATES: Comments must be submitted on or before November 30, 2013.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
[email protected]. Please refer to ``OMB

[[Page 66106]]

Control No. 2900-0091'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0091, 
Application and Renewal for Health Benefits.''

SUPPLEMENTARY INFORMATION:
    Title: Application and Renewal for Health Benefits, VA Form 10-
10EZ; 10-10EZR; 10-10HS.
    Type of Review: Revision of an existing collection.
    a. Abstract: Veterans complete VA Form 10-10EZ to enroll in VA 
health care system. VA will use the information collected to determine 
the veteran's eligibility for medical benefits.
    b. Veterans currently enrolled in VA health care system complete VA 
Form 10-10EZR to update their personal information such as marital 
status, address, health insurance and financial information.
    c. VA Form 10-10HS collects information only from veterans who are 
in a copay required status for hospital care and medical services, but 
due to a loss of income project their income for the current year will 
be substantially below the VA means test threshold.
    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 July 2, 2013, Vol. 78, No. 127, at pages 
39832-39833.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 455,750.
    Estimated Average Burden per Respondent: 26.8 minutes.
    Frequency of Response: Once.
    Estimated Number of Respondents: 1,017,000.

    By direction of the Secretary.

    Dated: October 30, 2013.
Crystal Rennie,
VA Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2013-26281 Filed 11-1-13; 8:45 am]
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