[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)]
[Notices]
[Pages 8129-8130]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03207]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0778]
Proposed Information Collection (Disability Benefits
Questionnaire (Group 3)); 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 DBQ title will include the name of the
specific disability for which it will gather information. VAF 21-0960C-
5, Central Nervous System and Neuromusculo Diseases Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of a central nervous system disease; VAF 21-0960C-8,
Headaches (Including Migraine Headaches) Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of headaches; VAF 21-0960C-9, Multiple Sclerosis (MS)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of multiple sclerosis; VAF 21-0960G-1,
Esophageal Disorders (including GERD, Hiatal Hernia, and Other
Esophageal Disorders) Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of any esophageal
disorders; VAF 21-0960G-2, Gall Bladder and Pancreas Conditions
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any gall bladder and pancreas condition;
VAF 21-0960G-3, Intestinal Conditions (Other than Surgical or
Infectious) Including Irritable Bowel Syndrome, Crohn's Disease,
Ulcerative Colitis, and Diverticulitis Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any intestinal conditions unrelated to surgery or
infection; VAF 21-0960G-4, Infectious Intestinal Disorders (including
Bacterial and Parasitic Infections) Disability Benefits Questionnaire,
will gather information related to the claimant's diagnosis of any
infectious intestinal condition; VAF 21-0960G-5, Hepatitis, Cirrhosis
and other Liver Conditions Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any liver
condition; VAF 21-0960G-6, Peritoneal Adhesions Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of peritoneal adhesions; VAF 21-0960G-7, Stomach and Duodenum
Conditions (Not Including GERD or Esophageal Disorders) Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any stomach or duodenum conditions; VAF 21-
0960G-8, Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of any surgical intestinal condition; VAF 21-
0960H-2, Rectum and Anus Conditions (Including Hemorrhoids) Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of any rectum or
[[Page 8130]]
anus condition, which includes hemorrhoids; VAF 21-0960K-1 Breast
Conditions and Disorders Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of a breast condition
or disorder; VAF 21-0960K-2 Gynecological Conditions Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of a gynecological condition; VAF 21-0960L-2,
Sleep Apnea Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of sleep apnea; VAF 21-0960M-11,
Osteomyelitis Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of osteomyelitis; VAF
21-0960N-1, Ear Conditions (Including Vestibular and Infectious)
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of an ear disease.
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. 2900-0778'' 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 3).
OMB Control Number: 2900-0778.
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: 77,500.
Estimated Average Burden per Respondent
i. VAF 21-0960C-5--30 minutes
ii. VAF 21-0960C-8--15 minutes
iii. VAF 21-0960C-9--45 minutes
iv. VAF 21-0960G-1--15 minutes
v. VAF 21-0960G-2--15 minutes
vi. VAF 21-0960G-3--15 minutes
vii. VAF 21-0960G-4--15 minutes
viii. VAF 21-0960G-5--30 minutes
ix. VAF 21-0960G-6--15 minutes
x. VAF 21-0960G-7--15 minutes
xi. VAF 21-0960G-8--15 minutes
xii. VAF 21-0960H-2--15 minutes
xiii. VAF 21-0960K-1--15 minutes
xiv. VAF 21-0960K-2--30 minutes
xv. VAF 21-0960L-2--15 minutes
xvi. VAF 21-0960M-11--15 minutes
xvii. VAF 21-0960N-1--15 minutes
Frequency of Response: One time.
Estimated Number of Respondents: 250,000.
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. 2016-03207 Filed 2-16-16; 8:45 am]
BILLING CODE 8320-01-P