[Federal Register Volume 76, Number 56 (Wednesday, March 23, 2011)]
[Notices]
[Pages 16478-16479]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-6759]
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DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900--New (DBQs--Group 2)]
Proposed Information Collection (Disability Benefits
Questionnaires--Group 2) Activity: Comment Request
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 new
collection and allow 60 days for public comment in response to the
notice. This notice solicits comments for information needed to obtain
medical evidence to adjudicate a claim for disability benefits.
DATES: Written comments and recommendations on the proposed collection
of information should be received on or before May 23, 2011.
ADDRESSES: Submit written comments on the collection of information
through Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits
Administration (20M33), Department of Veterans Affairs, 810 Vermont
Avenue, NW., Washington, DC 20420 or e-mail to [email protected].
Please refer to ``OMB Control No. 2900--New (DBQs--Group 2)'' in any
correspondence. During the comment period, comments may be viewed
online through FDMS.
FOR FURTHER INFORMATION CONTACT: Nancy J. Kessinger at (202) 461-9769
or FAX (202) 275-5947.
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, 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.
[[Page 16479]]
Titles
a. Arteries and Veins Conditions (Vascular Diseases including
Varicose Veins) Disability Benefits Questionnaire, VA Form 21-0960A-2.
b. Hypertension Disability Benefits Questionnaire, VA Form 21-
0960A-3.
c. Non-ischemic Heart Disease (including Arrhythmias and Surgery)
Disability Benefits Questionnaire, VA Form 21-0960A-4.
d. Diabetic Peripheral Neuropathy (Diabetic Sensory-Motor
Peripheral Neuropathy) Disability Benefits Questionnaire, VA Form 21-
0960C-4.
e. Diabetes Mellitus Disability Benefits Questionnaire, VA Form 21-
0960E-1.
f. Scar/Disfigurement Disability Benefits Questionnaire, VA Form
21-0960F-1.
g. Skin Diseases Disability Benefits Questionnaire, VA Form 21-
0960F-2.
h. Amputations Disability Benefits Questionnaire, VA Form 21-0960M-
1.
i. Ankle Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-2.
j. Elbow and Forearm Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-4.
k. Flatfoot (PES PLANUS) Disability Benefits Questionnaire, VA Form
21-0960M-5.
l. Foot Miscellaneous (other than flatfoot/PES PLANUS), Disability
Benefits Questionnaire, VA Form 21-0960M-6.
m. Hand and Finger Conditions Disability Benefits Questionnaire, VA
Form 21-0960M-7.
n. Hip and Thigh Conditions Disability Benefits Questionnaire, VA
Form 21-0960M-8.
o. Knee and Lower Leg Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-9.
p. Muscle Injuries Disability Benefits Questionnaire, VA Form 21-
0960M-10.
q. Shoulder and Arm Conditions Disability Benefits Questionnaire,
VA Form 21-0960M-12.
r. Temporomandibular Joint (TMJ) Conditions Disability Benefits
Questionnaire, VA Form 21-0960M-15.
s. Wrist Conditions Disability Benefits Questionnaire, VA Form 21-
0960M-16.
t. Eye Conditions Disability Benefits Questionnaire, VA Form 21-
0960N-2.
OMB Control Number: 2900--New (DBQs--Group 2).
Type of Review: New collection.
Abstract: Data collected on VA Form 21-0960 series will be used to
obtain information from claimants treating physician that is necessary
to adjudicate a claim for disability benefits.
Affected Public: Individuals or households.
Estimated Annual Burden
a. VA Form 21-0960A-2--10,000.
b. VA Form 21-0960A-3--12,500.
c. VA Form 21-0960A-4--10,000.
d. VA Form 21-0960C-4--37,500.
e. VA Form 21-0960E-1--18,750.
f. VA Form 21-0960F-1--6,250.
g. VA Form 21-0960F-2--6,250.
h. VA Form 21-0960M-1--12,500.
i. VA Form 21-0960M-2--15,000.
j. VA Form 21-0960M-4--10,000.
k. VA Form 21-0960M-5--12,500.
l. VA Form 21-0960M-6--7,500.
m. VA Form 21-0960M-7--15,000.
n. VA Form 21-0960M-8--25,000.
o. VA Form 21-0960M-9--25,000.
p. VA Form 21-0960M-10--15,000.
q. VA Form 21-0960M-12--25,000.
r. VA Form 21-0960M-15--3,750.
s. VA Form 21-0960M-16--20,000.
t. VA Form 21-0960N-2--30,000.
Estimated Average Burden per Respondent
a. VA Form 21-0960A-2--30 minutes.
b. VA Form 21-0960A-3--15 minutes.
c. VA Form 21-0960A-4--30 minutes.
d. VA Form 21-0960C-4--30 minutes.
e. VA Form 21-0960E-1--15 minutes.
f. VA Form 21-0960F-1--15 minutes.
g. VA Form 21-0960F-2--15 minutes.
h. VA Form 21-0960M-1--30 minutes.
i. VA Form 21-0960M-2--30 minutes.
j. VA Form 21-0960M-4--30 minutes.
k. VA Form 21-0960M-5--15 minutes.
l. VA Form 21-0960M-6--15 minutes.
m. VA Form 21-0960M-7--30 minutes.
n. VA Form 21-0960M-8--30 minutes.
o. VA Form 21-0960M-9--30 minutes.
p. VA Form 21-0960M-10--30 minutes.
q. VA Form 21-0960M-12--30 minutes.
r. VA Form 21-0960M-15--15 minutes.
s. VA Form 21-0960M-16--30 minutes.
t. VA Form 21-0960N-2--45 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents
a. VA Form 21-0960A-2--20,000.
b. VA Form 21-0960A-3--50,000.
c. VA Form 21-0960A-4--20,000.
d. VA Form 21-0960C-4--75,000.
e. VA Form 21-0960E-1--75,000.
f. VA Form 21-0960F-1--25,000.
g. VA Form 21-0960F-2--25,000.
h. VA Form 21-0960M-1--25,000.
i. VA Form 21-0960M-2--30,000.
j. VA Form 21-0960M-4--20,000.
k. VA Form 21-0960M-5--50,000.
l. VA Form 21-0960M-6--30,000.
m. VA Form 21-0960M-7--30,000.
n. VA Form 21-0960M-8--50,000.
o. VA Form 21-0960M-9--50,000.
p. VA Form 21-0960M-10--30,000.
q. VA Form 21-0960M-12--50,000.
r. VA Form 21-0960M-15--15,000.
s. VA Form 21-0960M-16--40,000.
t. VA Form 21-0960N-2--40,000.
By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2011-6759 Filed 3-22-11; 8:45 am]
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