[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