77488 Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices 

c. VA Form 10–10143b will collect 

health records of covered Veterans from 

non-VA health care entities and 

providers for care authorized under the 

VCCP, as required by 38 U.S.C. 

1703(a)(2)(A), which requires VA to 

establish a mechanism to receive 

medical records from non-VA providers. 

A copy of all medical and dental records 

(including but not limited to images, 

test results, and notes or other records 

of what care was provided and why) 

related to a Veteran’s care provided 

under the VCCP must be submitted to 

VA, including any claims for payment 

for the furnishing of such care. 

d. VA Form 10–10143c will collect 

information from non-VA entities and 

providers concerning relevant 

credentials and licenses as required for 

such entities or providers to furnish care 

and services generally. This information 

is authorized by section 133 of the 

MISSION Act, which requires VA to 

establish competency standards for nonVA providers, as well as 38 U.S.C. 

1703C(a)(1), which requires VA to 

establish certain standards of quality for 

furnishing care and services (including 

through non-VA providers). 

e. VA Form 10–10143e will collect 

secondary authorization requests from 

non-VA entities and providers to 

furnish care and services in addition to 

or supporting the original authorization 

for care. This information is required by 

38 U.S.C. 1703(a)(3), which establishes 

that a covered Veteran may only receive 

care or services under the VCCP upon 

VA’s authorization of such care or 

services. 

f. VA Form 10–10143f will allow for 

the submission of paper documents in 

support of a non-VA provider claim for 

emergency care rendered in the 

community when not accompanied by a 

paper Health Care Claim form. This 

Community Care Document Cover Sheet 

will be used exclusively for the 

submission of medical documentation 

for unauthorized emergent services for 

patients otherwise covered by VA. 

g. VA Form 10–10143g will be used 

to provide 72-hour notification to VA 

when a Veteran receives emergent care 

from a non-VA provider. This form 

should be completed by the non-VA 

provider within 72 hours of the 

beginning of treatment. 

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 at 85 FR 

158 on August 14, 2020, pages 49720 

and 49721. 

VA Form 10–10143 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 610,833 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

3,665,000. 

VA Form 10–10143a 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 610,833 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

3,665,000. 

VA Form 10–10143b 

Affected Public: Private Sector. 

Estimated Annual Burden: 1,039,332 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Average of 34 

times annually. 

Estimated Number of Respondents: 

366,823. 

VA Form 10–10143c 

Affected Public: Private Sector. 

Estimated Annual Burden: 10,190 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

122,274. 

VA Form 10–10143e 

Affected Public: Private Sector. 

Estimated Annual Burden: 611,372 

hours. 

Estimated Average Burden per 

Respondent: 20 minutes. 

Frequency of Response: Average of 5 

times annually. 

Estimated Number of Respondents: 

366,823. 

VA Form 10–10143f 

Affected Public: Private Sector. 

Estimated Annual Burden: 41,667 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

500,000. 

VA Form 10–10143g 

Affected Public: Private Sector. 

Estimated Annual Burden: 83,333 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

500,000. 

By direction of the Secretary. 

Danny S. Green, 

Interim VA Clearance Officer, Office of 

Quality, Performance and Risk (OQPR), 

Department of Veterans Affairs. 

[FR Doc. 2020–26575 Filed 12–1–20; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0882] 

Agency Information Collection Activity 

Under OMB Review: Chapter 31 

Request for Assistance 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 

1995, this notice announces that the 

Veterans Benefits 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 it includes the 

actual data collection instrument. 

DATES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. Refer to ‘‘OMB Control 

No. 2900–0882. 

FOR FURTHER INFORMATION CONTACT: 

Danny S. Green, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 811 Vermont Avenue 

NW, Washington, DC 20420, (202) 421– 

1354 or email danny.green2@va.gov. 

Please refer to ‘‘OMB Control No. 2900– 

0882’’ in any correspondence. 

SUPPLEMENTARY INFORMATION: 

Authority: 38 U.S.C. 3100, 38 U.S.C. 

501. 

Title: Chapter 31 Request for 

Assistance (VA Form 28–10212). 

OMB Control Number: 2900–0882. 

Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices 77489 

Type of Review: Extension of a 

currently approved collection. 

Abstract: VA Form 28–10212 is used 

to gather specific information regarding 

a claimant’s request for services, 

supplies, or equipment that are 

necessary to participate in the Chapter 

31 program. 

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 at insert 

citation date, 85 FR 182 on September, 

18, 2020, pages 58428 and 58429. 

Affected Public: Individuals. 

Estimated Annual Burden: 83. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: One time. 

Estimated Number of Respondents: 

500. 

By direction of the Secretary. 

Danny S. Green, 

VA PRA Clearance Officer, Office of Quality, 

Performance and Risk, Department of 

Veterans Affairs. 

[FR Doc. 2020–26566 Filed 12–1–20; 8:45 am] 

BILLING CODE 8320–01–P