69992 Federal Register / Vol. 69, No. 230 / Wednesday, December 1, 2004 / Notices 

Estimated Average Burden Per 

Respondent: 15 minutes. 

Frequency of Response: On Occasion. 

Estimated Number of Respondents:

67,844.

Dated: November 22, 2004.

By direction of the Secretary. 

Loise Russell, 

Director, Records Management Service.

[FR Doc. 04–26463 Filed 11–30–04; 8:45 am] 

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0114] 

Proposed Information Collection 

Activity: Proposed Collection; 

Comment Request

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs.

ACTION: Notice.

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 

revision of a currently approved 

collection, and allow 60 days for public 

comment in response to this notice. 

This notice solicits comments on the 

information needed to determine the 

validity of a common law marriage.

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before January 31, 2005.

ADDRESSES: Submit written comments 

on the collection of information to 

Nancy J. Kessinger, Veterans Benefits 

Administration (20M35), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420 or e-mail: 

irmnkess@vba.va.gov. Please refer to 

‘‘OMB Control No. 2900–0114’’ in any 

correspondence.

FOR FURTHER INFORMATION CONTACT:

Nancy J. Kessinger at (202) 273–7079 or 

FAX (202) 275–5947.

SUPPLEMENTARY INFORMATION: Under the 

PRA of 1995 (Pub. L. 104–13; 44 U.S.C., 

3501–3520), 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. 

Title: Statement of Marital 

Relationship, VA Form 21–4170. 

OMB Control Number: 2900–0114. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: Persons claiming to be 

common law widows/widowers of 

deceased veterans and veterans and 

their claimed common law spouses 

complete VA Form 21–4170 to establish 

marital status. VA uses the information 

collected to determine whether the 

common law marriage was valid under 

the law of the place where the parties 

resided at the time of the marriage or 

under the law of the place where the 

parties resided when the right to 

benefits accrued. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 2,708 

hours. 

Estimated Average Burden Per 

Respondent: 25 minutes. 

Frequency of Response: On occasion. 

Estimated Number of Respondents:

6,500.

Dated: November 22, 2004. 

By direction of the Secretary. 

Loise Russell, 

Director, Records Management Service.

[FR Doc. 04–26464 Filed 11–30–04; 8:45 am] 

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0621] 

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 

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 consider if a medical 

malpractice payment is related to 

substandard care, professional 

incompetence or professional 

misconduct on the part of a physician, 

dentist, or other health care practitioner.

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before January 31, 2005.

ADDRESSES: Submit written comments 

on the collection of information to Ann 

Bickoff, Veterans Health Administration 

(193E1), Department of Veterans Affairs, 

810 Vermont Avenue, NW., 

Washington, DC 20420 or e-mail 

ann.bickoff@mail.va.gov. Please refer to 

‘‘OMB Control No. 2900–0621’’ in any 

correspondence.

FOR FURTHER INFORMATION CONTACT: Ann 

Bickoff at (202) 273–8310.

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. 

Title: National Practitioner Data Bank 

Regulations. 

OMB Control Number: 2900–0621. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: The National Practitioner 

Data Bank was established for the 

purpose of collecting and releasing 

Federal Register / Vol. 69, No. 230 / Wednesday, December 1, 2004 / Notices 69993

certain information concerning 

physicians, dentists, and other licensed 

health care practitioners. VA will obtain 

information from the National 

Practitioner Data Bank concerning 

physicians, dentists, and other licensed 

health care practitioners who provide or 

seek to provide health care services at 

VA facilities and report information 

regarding malpractice payments and 

adverse clinical privileges action to the 

National Practitioner Data Bank. 

Affected Public: Individuals or 

households. 

Estimated Total Annual Burden:

1,750 hours. 

Estimated Average Burden Per 

Respondent: 5 hours. 

Frequency of Response: One time. 

Estimated Number of Respondents:

350.

Dated: November 22, 2004.

By direction of the Secretary. 

Loise Russell, 

Director, Records Management Service.

[FR Doc. 04–26465 Filed 11–30–04; 8:45 am] 

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–New] 

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 new 

collection, and allow 60 days for public 

comment in response to the notice. This 

notice solicits comments on information 

needed to file a civil rights 

discrimination complaint.

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before January 31, 2005.

ADDRESSES: Submit written comments 

on the collection of information to Ann 

Bickoff, Veterans Health Administration 

(193E1), Department of Veterans Affairs, 

810 Vermont Avenue, NW., 

Washington, DC 20420 or e-mail 

ann.bickoff@mail.va.gov. Please refer to 

‘‘OMB Control No. 2900–New’’ in any 

correspondence.

FOR FURTHER INFORMATION CONTACT: Ann 

Bickoff at (202) 273–8310.

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. 

Title: Civil Rights Discrimination 

Complaint, VA Form 10–0381. 

OMB Control Number: 2900–New. 

Type of Review: New collection. 

Abstract: VA Form 10–0381 is 

completed by veterans and other VHA 

customers who believe their civil rights 

were discriminated by agency 

employees while receiving medical care 

or services in VA medical centers, or 

institutions such as state homes 

receiving federal financial assistance 

from VA to file a formal complaint of 

the alleged discrimination. 

Affected Public: Individuals or 

households. 

Estimated Total Annual Burden: 46 

hours. 

Estimated Average Burden Per 

Respondent: 15 minutes. 

Frequency of Response: On occasion. 

Estimated Number of Respondents:

183.

Dated: November 22, 2004.

By direction of the Secretary. 

Loise Russell, 

Director, Records Management Service.

[FR Doc. 04–26466 Filed 11–30–04; 8:45 am] 

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0653] 

Proposed Information Collection 

Activity: Proposed Collection; 

Comment Request

AGENCY: Veterans Health 

Administration, Department of Veterans 

Affairs.

ACTION: Notice.

SUMMARY: The Veterans Health 

Administration (VHA), 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 

extension of a currently approved 

collection, and allow 60 days for public 

comment in response to the notice. This 

notice solicits comments for information 

to determine how veterans want to 

receive information about bio-terrorism.

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before January 31, 2005.

ADDRESSES: Submit written comments 

on the collection of information to Ann 

W. Bickoff, Veterans Health 

Administration (193E1), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420 or e-mail 

ann.bickoff@hq.med.va.gov. Please refer 

to ‘‘OMB Control No. 2900–0653’’ in 

any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann 

W. Bickoff (202) 273–8310 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