[Federal Register Volume 75, Number 147 (Monday, August 2, 2010)]
[Notices]
[Pages 45206-45207]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-18814]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-0188]
Proposed Information Collection (Claim, Authorization and Invoice
for Prosthetic Items and Services) Activity: Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
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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 extension of a currently approved collection, and allow
60 days for public comment in response to the notice. This notice
solicits comments on information needed to determine eligibility and
authorize funding for various prosthetic services.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before September 1, 2010.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at http://www.Regulations.gov; or to Mary Stout, Veterans Health Administration
(193E1), Department of Veterans Affairs, 810 Vermont Avenue, NW.,
Washington, DC 20420 or e-mail: [email protected]. Please refer to
``OMB Control No. 2900-0188'' in any correspondence. During the comment
period, comments may be viewed online through FDMS.
FOR FURTHER INFORMATION CONTACT: Mary Stout (202) 461-5867 or FAX (202)
273-9381.
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) 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.
Titles:
a. Veterans Application for Assistance in Acquiring Home
Improvement and Structural Alterations, VA Form 10-0103.
b. Application for Adaptive Equipment Motor Vehicle, VA Form 10-
1394.
c. Prosthetic Authorization for Items or Services, VA Form 10-2421.
d. Prosthetic Service Card Invoice, VA Form 10-2520.
e. Prescription and Authorization for Fee Basis Eyeglasses, VA Form
10-2914.
f. Request to Submit Quotation, Form Letter 10-90.
OMB Control Number: 2900-0188.
Type of Review: Extension of a currently approved collection.
Abstract: The following forms are used to determine eligibility,
prescribe, and authorize prosthetic devices.
a. VA Form 10-0103 is used to determine eligibility/entitlement and
reimbursement of individual claims for home improvement and structural
alterations.
b. VA Form 10-1394 is used to determine eligibility/entitlement and
reimbursement of individual claims for automotive adaptive equipment.
[[Page 45207]]
c. VA Form 10-2421 is used for the direct procurement of new
prosthetic appliances and/or services.
d. VA Form 10-2520 is used by the vendors as an invoice and billing
document. The form standardizes repair/treatment invoices for
prosthetic services rendered and standardizes the verification of these
invoices. The veteran certifies that the repairs were necessary and
satisfactory. This form is furnished to vendors upon request.
e. VA Form 10-2914 is used as a combination prescription,
authorization and invoice as well as to purchase eyeglasses directly
for Veterans.
f. VA Form Letter 10-90 is used to obtain to a quotation price for
prosthetic devices.
Affected Public: Business or other for profit and individuals or
households.
Estimated Total Annual Burden:
a. VA Form 10-0103--583.
b. VA Form 10-1394--1,000.
c. VA Form 10-2421--67.
d. VA Form 10-2520--47.
e. VA Form 10-2914--3,333.
f. Form Letter 10-90--708.
Estimated Average Burden per Respondent:
a. VA Form 10-0103--5 minutes.
b. VA Form 10-1394--15 minutes.
c. VA Form 10-2421--4 minutes.
d. VA Form 10-2520--4 minutes.
e. VA Form 10-2914--4 minutes.
f. Form Letter 10-90--5 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents:
a. VA Form 10-0103--7,000.
b. VA Form 10-1394--4,000.
c. VA Form 10-2421--1,000.
d. VA Form 10-2520--700.
e. VA Form 10-2914--50,000.
f. Form Letter 10-90--8,500.
Dated: July 27, 2010.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010-18814 Filed 7-30-10; 8:45 am]
BILLING CODE 8320-01-P