[Federal Register Volume 82, Number 79 (Wednesday, April 26, 2017)]
[Notices]
[Pages 19311-19312]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-08440]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0776]
Agency Information Collection Activity: Artery and Vein
Conditions (Vascular Diseases Including Varicose Veins) Disability
Benefits Questionnaire, Hypertension Disability Benefits Questionnaire,
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery)
Disability Benefits Questionnaire, Diabetic Peripheral Neuropathy
(Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits
Questionnaire, Diabetes Mellitus Disability Benefits Questionnaire,
Scars/Disfigurement Disability Benefits Questionnaire, Skin Diseases
Disability Benefits Questionnaire, Amputations Disability Benefits
Questionnaire, Muscles Injuries Disability Benefits Questionnaire,
Temporomandibular Joint (TMJ) Conditions Disability Benefits
Questionnaire, Eye Conditions Disability Benefits Questionnaire
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.
VA Form 21-0960 series is used to gather necessary information from
a claimant's treating physician regarding the results of medical
examinations. VA gathers 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 21-0960A-
2, Artery and Vein Conditions vascular diseases including varicose
veins) Disability Benefits Questionnaire, will gather information
related to the claimant's diagnosis of arteries, veins, and/or
peripheral vascular disease; VAF 21-0960A-3, Hypertension, Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of hypertension; VAF 21-0960A-4, Non-ischemic
Heart Disease (including Arrhythmias and Surgery) Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any non-ischemic heart disease; VAF 21-0960C-4, Diabetic
Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy)
Disability Benefits Questionnaire will gather information related to
the claimant's diagnosis of a diabetic sensory-motor peripheral
neuropathy condition; VAF 21-0960E-1, Diabetes Mellitus Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of diabetes mellitus; VAF 21-0960F-1, Scars/
Disfigurement Disability Benefits Questionnaire will gather information
related to the claimant's diagnosis of any scars or disfigurement; VAF
21-0960F-2, Skin Diseases Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any skin
disease. VAF 21-0960M-1 Amputations Disability Benefits Questionnaire,
will gather information related to the claimant's amputations; VAF 21-
0960M-10 Muscle Injuries Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of a muscle injury
disability. VAF 21-0960M-15 Temporomandibular Joint (TMJ) Conditions
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of temporomandibular joint dysfunction or TMJ.
VAF 21-0960N-2 Eye Conditions Disability Benefits Questionnaire will
gather information related to the claimant's diagnosis of an eye
condition.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before June 26, 2017.
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. 2900-0776'' in any correspondence. During the comment
[[Page 19312]]
period, comments may be viewed online through the FDMS.
FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 632-8924
or FAX (202) 632-8925.
SUPPLEMENTARY INFORMATION: Under the PRA of 1995, 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.
Authority: Public Law 104-13; 44 U.S.C. 3501-21.
Title: (Artery and Vein Conditions (Vascular Diseases Including
Varicose Veins) Disability Benefits Questionnaire (VA Form 21-0960A-2),
Hypertension Disability Benefits Questionnaire (VA Form 21-0960A-3),
Non-Ischemic Heart Disease (Including Arrhythmias and Surgery)
Disability Benefits Questionnaire (VA Form 21-0960A-4), Diabetic
Peripheral Neuropathy (Diabetic Sensory-Motor Peripheral Neuropathy)
Disability Benefits Questionnaire (VA Form 21-0960C-4), Diabetes
Mellitus Disability Benefits Questionnaire (VA Form 21-0960E-1), Scars/
Disfigurement Disability Benefits Questionnaire (VA Form 21-0960F-1),
Skin Diseases Disability Benefits Questionnaire (VA Form 21-0960F-2),
Amputations Disability Benefits Questionnaire (VA Form 21-0960M-1),
Muscles Injuries Disability Benefits Questionnaire (VA Form 21-0960M-
10), Temporomandibular Joint (TMJ) Conditions Disability Benefits
Questionnaire (VA Form 21-0960M-15), Eye Conditions Disability Benefits
Questionnaire (VA Form 21-0960N-2)).
OMB Control Number: 2900-0776.
Type of Review: Extension of an approved collection.
Abstract: VA Form 21-0960 series is used to gather necessary
information from a claimant's treating physician regarding the results
of medical examinations. VA gathers 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 21-0960A-2, Artery and Vein Conditions vascular diseases including
varicose veins) Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of arteries, veins,
and/or peripheral vascular disease; VAF 21-0960A-3, Hypertension,
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of hypertension; VAF 21-0960A-4, Non-ischemic
Heart Disease (including Arrhythmias and Surgery) Disability Benefits
Questionnaire, will gather information related to the claimant's
diagnosis of any non-ischemic heart disease; VAF 21-0960C-4, Diabetic
Peripheral Neuropathy (diabetic sensory-motor peripheral neuropathy)
Disability Benefits Questionnaire will gather information related to
the claimant's diagnosis of a diabetic sensory-motor peripheral
neuropathy condition; VAF 21-0960E-1, Diabetes Mellitus Disability
Benefits Questionnaire, will gather information related to the
claimant's diagnosis of diabetes mellitus; VAF 21-0960F-1, Scars/
Disfigurement Disability Benefits Questionnaire will gather information
related to the claimant's diagnosis of any scars or disfigurement; VAF
21-0960F-2, Skin Diseases Disability Benefits Questionnaire, will
gather information related to the claimant's diagnosis of any skin
disease. VAF 21-0960M-1 Amputations Disability Benefits Questionnaire,
will gather information related to the claimant's amputations; VAF 21-
0960M-10 Muscle Injuries Disability Benefits Questionnaire, will gather
information related to the claimant's diagnosis of a muscle injury
disability. VAF 21-0960M-15 Temporomandibular Joint (TMJ) Conditions
Disability Benefits Questionnaire, will gather information related to
the claimant's diagnosis of temporomandibular joint dysfunction or TMJ.
VAF 21-0960N-2 Eye Conditions Disability Benefits Questionnaire will
gather information related to the claimant's diagnosis of an eye
condition.
Affected Public: Individuals or households.
Estimated Annual Burden: 162,500.
Estimated Average Burden per Respondent: 25 minutes.
Frequency of Response: One time.
Estimated Number of Respondents: 400,000.
By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Enterprise Records Service, Office of
Quality and Compliance, Department of Veterans Affairs.
[FR Doc. 2017-08440 Filed 4-25-17; 8:45 am]
BILLING CODE 8320-01-P