[Federal Register Volume 80, Number 148 (Monday, August 3, 2015)]
[Notices]
[Pages 46104-46105]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18925]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0648]
Proposed Information Collection (Foreign Medical Program
Application and Claim Cover Sheet) Activity: 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 identify areas for
improvement in clinical training programs.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before October 2, 2015.
ADDRESSES: Submit written comments on the collection of information
through the Federal Docket Management System (FDMS) at
www.Regulations.gov; or to Brian McCarthy, Office of Regulatory and
Administrative Affairs, 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. 2900-0648'' in any correspondence. During the comment period,
comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Brian McCarthy at (202) 461-6345.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C. 3501-3521), Federal agencies must obtain approval from 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:
1. Foreign Medical Program (FMP) Registration Form.
2. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP).
OMB Control Number: 2900-0648.
Type of Review: Extension of a currently approved collection.
Abstracts: This information collection is needed to carry out the
health care benefits allowed by the Foreign Medical Program (FMP). It
is a federal health benefits program for Veterans administered by the
Department of Veterans Affairs (VA) Veterans Health Administration
(VHA). FMP is a Fee for Service (indemnity plan) program. FMP provides
reimbursement for VA adjudicated service-connected conditions. Title 38
CFR 17.35 states that the VA will provide coverage for the Veteran's
service-connected disability when the Veteran is residing or traveling
overseas.
VA Form 10-7959f-1, Foreign Medical Program (FMP) Registration
Form, is used to register into the Foreign Medical Program those
Veterans with service-connected disabilities that are living or
traveling overseas. Title 38 CFR 17.125(d) states that requests for
consideration of claim reimbursement from approved health care
providers and Veterans are to be mailed to VHA Health Administration
Center (HAC). The VA Form 10-7959f-2, Claim Cover Sheet--Foreign
Medical Program streamlines the claims submission process for claimants
or physicians while also reducing the time spent by VA on processing
FMP claims. The cover sheet will allow foreign providers/Veterans with
a better understanding of basic information required for the processing
and payment of claims.
Affected Public: Individuals or households.
Estimated Annual Burden:
a. Foreign Medical Program (FMP) Registration Form--fill, VA Form
10-7959f-1--111 hours.
b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form
10-7959f-2--3,652 hours.
Estimated Average Burden per Respondent:
a. Foreign Medical Program (FMP) Registration Form--fill, VA Form
10-7959f-1--4 minutes.
b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form
10-7959f-2--11 minutes.
Frequency of Response:
a. Foreign Medical Program (FMP) Registration Form--fill, VA Form
10-7959f-1--Annually
b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form
10-7959f-2 --12 times a year.
Estimated Annual Responses:
a. Foreign Medical Program (FMP) Registration Form--fill, VA Form
10-7959f-1--1,660.
b. CLAIM COVER SHEET--FOREIGN MEDICAL PROGRAM (FMP)--fill, VA Form
10-7959f-2--19,920.
[[Page 46105]]
By direction of the Secretary.
Kathleen M. Manwell,
Program Analyst, VA Privacy Service, Office of Privacy and Records
Management, Department of Veterans Affairs.
[FR Doc. 2015-18925 Filed 7-31-15; 8:45 am]
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