[Federal Register Volume 75, Number 131 (Friday, July 9, 2010)]
[Notices]
[Pages 39622-39623]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-16783]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-New (10-0505)]
Proposed Information Collection (Health Resource Center Medical
Center Payment Form) Activity: Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995
(44 U.S.C. 3501-3521), this notice announces that the Veterans Health
Administration, Department of Veterans Affairs, will submit the
collection of information abstracted below to the Office of Management
and Budget (OMB) for review and comment. The PRA submission describes
the nature of the information collection and its expected cost and
burden and includes the actual data collection instrument.
DATES: Comments must be submitted on or before August 9, 2010.
ADDRESSES: Submit written comments on the collection of information
through http://www.Regulations.gov or to VA's OMB Desk Officer, OMB
Human Resources and Housing Branch, New Executive Office Building, Room
10235, Washington, DC 20503 (202) 395-7316. Please refer to ``OMB
Control No. 2900-New (10-0505).''
FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420, (202) 461-7485, fax (202) 273-0443 or e-mail
[email protected]. Please refer to ``OMB Control No. 2900-New (10-
0505).''
Title: Health Resource Center Medical Center Payment Form, VA Form
10-0505.
OMB Control Number: 2900-New (10-0505).
Type of Review: Existing collection in used without an OMB control
number.
Abstract: Data collected on VA Form 10-0505 will be used to allow
claimants with medical care copayment debts to pay online with a credit
card or Automated Clearing House transaction.
An agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a
currently valid OMB control number. The Federal Register Notice with a
60-day comment period soliciting comments on this collection of
information was published on April 28, 2010, at page 22438.
[[Page 39623]]
Affected Public: Individuals or households.
Estimated Total Annual Burden: 48,000.
Estimated Average Burden per Respondent: 4 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 60,000.
Estimated Number of Responses: 720,000.
Dated: July 6, 2010.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010-16783 Filed 7-8-10; 8:45 am]
BILLING CODE 8320-01-P