[Federal Register Volume 78, Number 127 (Tuesday, July 2, 2013)]
[Pages 39832-39833]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-15811]



[OMB Control No. 2900-0091]

Proposed Information Collection Activity: Proposed Collection; 
Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.


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 revision of a currently approved collection, and allow 60 
days for public comment in response to the notice. This notice solicits 
comments on the information needed to enroll veterans into the VA 
health care system and to update an existing enrollee's personal data.

[[Page 39833]]

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before September 3, 2013.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov; or to Cynthia Harvey-Pryor, 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. 2900-0091'' in any 
correspondence. During the comment period, comments may be viewed 
online through the Federal Docket Management System (FDMS) at 

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), 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, 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) way 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.
    a. Application for Health Benefits, VA Form 10-10EZ.
    b. Health Benefits Renewal Form, VA Form 10-10EZR.
    c. VA Form 10-10HS.
    OMB Control Number: 2900-0091.
    Type of Review: Revision of a currently approved collection.
    a. 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 martial 
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.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 1,017,000 hours.
    a. VA Form 10-10EZ--250,000.
    b. VA Form 10-10EZR--204,000.
    c. VA Form 10-10HS--1750.
    Estimated Average Burden Per Respondent:
    a. VA Form 10-10EZ--30 minutes.
    b. VA Form 10-10EZR--24 minutes.
    c. VA Form 10-10HS--15 minutes.
    Frequency of Response: Annually.
    Estimated Number of Respondents: 1,017,000.
    a. VA Form 10-10EZ--500,000.
    b. VA Form 10-10EZR--510,000.
    c. VA Form 10-10HS--7,000.

    Dated: June 27, 2013.

    By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, U.S. Department of Veterans Affairs.
[FR Doc. 2013-15811 Filed 7-1-13; 8:45 am]