[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)]
[Notices]
[Pages 8128-8129]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03206]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0781]
Proposed Information Collection (Disability Benefits
Questionnaire (Group 4)) Activity: Comment Request
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
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SUMMARY: The Veterans Benefits Administration (VBA), Department of
Veterans Affairs (VA), 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.
The VA Form 21-0960 series will be used to gather necessary
information from a claimant's treating physician regarding the results
of medical examinations. VA will gather medical information related to
the claimant that is necessary to adjudicate the claim for VA
disability benefits. The Disability Benefit Questionnaire title will
include the name of the specific disability for which it will gather
information. VAF 21-0960C-3, Cranial Nerve Conditions Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any cranial nerve condition; VAF 21-0960C-6,
Narcolepsy Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of narcolepsy; VAF 21-0960C-7,
Fibromyalgia Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of fibromyalgia; VAF 21-0960C-11,
Seizure Disorders (Epilepsy) Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any seizure
disorder including epilepsy; VAF 21-0960D-1, Oral and Dental Conditions
Including Mouth, Lips and Tongue (Other than Temporomandibular Joint
Conditions) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any oral or dental conditions;
VAF 21-0960E-2, Endocrine Diseases (Other Than Thyroid, Parathyroid, or
Diabetes Mellitus) Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of any endocrine
disease including cushings and acromegaly however, excluding diabetes;
VAF 21-0960E-3, Thyroid & Parathyroid Conditions Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any thyroid or parathyroid condition; VAF 21-0960H-1,
Hernias (Including Abdominal, Inguinal, and Femoral Hernias) Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of abdominal, inguinal, or femoral hernias; VAF
21-0960I-2, HIV-Related Illness Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any HIV-
related illness; VAF 21-0960I-3, Infectious Diseases Other Than HIV-
Related Illness, Chronic Fatigue Syndrome, and Tuberculosis Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any infectious diseases; VAF 21-0960I-4,
Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of lupus or other immune disorders; VAF 21-
0960I-5, Nutritional Deficiencies Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of
nutritional deficiencies; VAF 21-0960J-4, Urinary Tract (including
Bladder & Urethra) Conditions (excluding Male Reproductive System)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any urinary tract or bladder condition; VAF
21-0960L-1, Respiratory Conditions (Other than Tuberculosis & Sleep
Apnea) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of any respiratory condition; VAF
21-0960N-3, Loss of Sense of Smell and/or Taste Disability Benefits
Questionnaire, will gather information related to the claimant's loss
of sense of smell and taste; VAF 21-0960N-4, Sinusitis/Rhinitis and
Other Conditions of the Nose, Throat, Larynx, and Pharynx Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of sinusitis/rhinitis
[[Page 8129]]
or other diseases of the nose, throat, larynx, or pharynx; VAF 21-
0960Q-1, Chronic Fatigue Syndrome Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of chronic
fatigue syndrome.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before April 18, 2016.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at www.Regulations.gov
or to Nancy J. Kessinger, Veterans Benefits Administration (20M33),
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC
20420 or email to [email protected]. Please refer to ``OMB Control
No. 2900-0781'' in any correspondence.
FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924
or FAX (202) 632-8925.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44
U.S.C. 3501-21), 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, VBA
invites comments on: (1) Whether the proposed collection of information
is necessary for the proper performance of VBA's functions, including
whether the information will have practical utility; (2) the accuracy
of VBA'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.
Title: Disability Benefits Questionnaires (Group 4).
OMB Control Number: 2900-0781.
Type of Review: Revision of a currently approved collection.
Abstract: The VA Form 21-0960 series will be used to gather
necessary information from a claimant's treating physician regarding
the results of medical examinations. VA will gather medical information
related to the claimant that is necessary to adjudicate the claim for
VA disability benefits.
Affected Public: Individuals or households.
Estimated Annual Burden: 53,750.
Estimated Average Burden per Respondent
i. VAF 21-0960C-3--30 minutes
ii. VAF 21-0960C-6--15 minutes
iii. VAF 21-0960C-7--15 minutes
iv. VAF 21-0960C-11--15 minutes
v. VAF 21-0960D-1--15 minutes
vi. VAF 21-0960E-2--15 minutes
vii. VAF 21-0960E-3--15 minutes
viii. VAF 21-0960H-1--15 minutes
ix. VAF 21-0960I-2--15 minutes
x. VAF 21-0960I-3--15 minutes
xi. VAF 21-0960I-4--30 minutes
xii. VAF 21-0960I-5--15 minutes
xiii. VAF 21-0960J-4--15 minutes
xiv. VAF 21-0960L-1--30 minutes
xv. VAF 21-0960N-3--15 minutes
xvi. VAF 21-0960N-4--30 minutes
xvii. VAF 21-0960Q-1--15 minutes
Frequency of Response: One time.
Estimated Number of Respondents: 160,000.
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. 2016-03206 Filed 2-16-16; 8:45 am]
BILLING CODE 8320-01-P